Cancer incidence and mortality in 23 000 patients with type 1 diabetes in the UK: Long‐term follow‐up

Anthony J. Swerdlow*, Michael E. Jones, Stefan D. Slater, Andrew C. F. Burden, Johannes L. Botha, Norman R. Waugh, Andrew D. Morris, Wendy Gatling, Kathleen M. Gillespie, Christopher C. Patterson, Minouk J. Schoemaker

*Corresponding author for this work

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Type 2 diabetes is associated with raised risk of several cancers, but for type 1 diabetes risk data are fewer and inconsistent We assembled a cohort of 23 473 UK patients with insulin-treated diabetes diagnosed at ages <30, almost all of whom will have had type 1 diabetes, and for comparison 5058 diagnosed at ages 30 to 49, of whom we estimate two-thirds will have had type 2, and followed them for an average of 30 years for cancer incidence and mortality compared with general population rates. Patients aged <30 at diabetes diagnosis had significantly raised risks only for ovarian (standardised incidence ratio = 1.58; 95% confidence interval 1.16-2.11; P < .01) and vulval (3.55; 1.94-5.96; P < .001) cancers, with greatest risk when diabetes was diagnosed at ages 10-14. Risks of cancer overall (0.89; 0.84-0.95; P < .001) and sites including lung and larynx were significantly diminished. Patients diagnosed with diabetes at ages 30 to 49 had significantly raised risks of liver (1.76;1.08-2.72) and kidney (1.46;1.03-2.00) cancers, and reduced risk of cancer overall (0.89; 0.84-0.95). The raised ovarian and vulval cancer risks in patients with type 1 diabetes, especially with diabetes diagnosed around pubertal ages, suggest possible susceptibility of these organs at puberty to metabolic disruption at diabetes onset. Reduced risk of cancer overall, particularly smoking and alcohol-related sites, might reflect adoption of a healthy lifestyle.
Original languageEnglish
Pages (from-to)512-523
Number of pages12
JournalInternational Journal of Cancer
Issue number3
Early online date15 May 2023
Publication statusPublished - 01 Aug 2023


  • cancer
  • cohort
  • type 1 diabetes


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