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Diabetes, plasma glucose and incidence of colorectal cancer in Chinese adults: a prospective study of 0.5 million people
  1. Yuanjie Pang1,
  2. Christiana Kartsonaki1,2,
  3. Yu Guo3,
  4. Yiping Chen1,2,
  5. Ling Yang1,2,
  6. Zheng Bian3,
  7. Fiona Bragg1,
  8. Iona Y Millwood1,2,
  9. Leijia Shen4,
  10. Songgen Zhou5,
  11. Jiben Liu6,
  12. Junshi Chen7,
  13. Liming Li3,8,
  14. Michael V Holmes1,2,9,
  15. Zhengming Chen1
  1. 1Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3Chinese Academy of Medical Sciences, Beijing, China
  4. 4Tongxiang Renmin Hospital, Tongxiang, China
  5. 5Wuzhen Central Hospital, Tongxiang, China
  6. 6Yongqing Road Community Health Center, Qingdao, China
  7. 7National Center for Food Safety Risk Assessment, Beijing, China
  8. 8School of Public Health, Peking University, Beijing, China
  9. 9National Institute for Health Research Oxford Biomedical Research Center, Oxford University Hospital, Oxford, UK
  1. Correspondence to Dr Christiana Kartsonaki, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; christiana.kartsonaki{at}


Background Diabetes is associated with higher risk of colorectal cancer (CRC). Uncertainty remains about the relevance of duration of diabetes and about the association of blood glucose with CRC risk among individuals without diabetes.

Methods The prospective China Kadoorie Biobank recruited 512 713 participants in 2004–2008 from 10 diverse areas in China. After 10 years of follow-up, 3024 incident cases of CRC (1745 colon, 1716 rectal) were recorded among 510 136 participants without prior cancer at baseline. Cox regression was used to estimate adjusted HRs for CRC associated with diabetes (previously diagnosed or screen-detected) and, among those without previously diagnosed diabetes, with levels of random plasma glucose (RPG).

Results Overall 5.8% of participants had diabetes at baseline. Individuals with diabetes had an adjusted HR of 1.18 (95% CI 1.04 to 1.33) for CRC, with similar risk for colon and rectal cancer (1.19 [1.01 to 1.39] vs 1.14 [0.96 to 1.35]). The HRs decreased with longer duration of diabetes (p for trend 0.03). Among those without previously diagnosed diabetes, RPG was positively associated with CRC, with adjusted HRs per 1 mmol/L higher baseline RPG of 1.04 (1.02 to 1.05) for CRC, again similar for colon and rectal cancer (1.03 [1.01to 1.05] and 1.04 [1.02 to 1.06], respectively). The associations of diabetes and RPG appeared stronger in men than in women, but the differences were non-significant (p for heterogeneity 0.3 and 0.2).

Discussion Among Chinese adults, diabetes and higher blood glucose levels among those without known diabetes are associated with higher risk of CRC.

  • diabetes
  • blood glucose
  • colorectal cancer
  • Chinese

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  • Contributors YP, CK, MVH and ZC conducted data analysis and are responsible for accuracy of the results and the decision to submit for publication. All authors were involved in study design, conduct, long-term follow-up, review and coding of disease events, interpretation of the results or writing the report.

  • Funding Baseline survey: Kadoorie Charitable Foundation, Hong Kong. Long-term continuation: UK Wellcome Trust (088158/Z/09/Z, 104085/Z/14/Z), Chinese Ministry of Science and Technology (2011BAI09B01, 2012-14), Chinese National Natural Science Foundation (81390541). The British Heart Foundation, UK Medical Research Council and Cancer Research UK provide core funding to the Oxford CTSU.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Central ethnics approvals were obtained from Oxford University and the China National Centre for Disease Control and Prevention (CDC). In addition, approvals were obtained from institutional research boards at the local CDCs in the 10 regions.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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