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Biological ageing and the risks of all-cause and cause-specific mortality among people with diabetes: a prospective cohort study
  1. Li Chen,
  2. Xingzhu Yin,
  3. Ying Zhao,
  4. Huimin Chen,
  5. Tianqi Tan,
  6. Ping Yao,
  7. Yuhan Tang
  1. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health and MOE Key Lab of Environment and Health, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, State Key Laboratory of Environment Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
  1. Correspondence to Dr Yuhan Tang, Huazhong University of Science and Technology, Wuhan, Hubei, China; 2015220157{at}


Background The aetiology of diabetes is complex with limited treatment strategies. Growing animal studies have shown that targeted antiageing can improve the outcomes of diabetes. However, population evidence is limited. This study aims to evaluate the associations of biological ageing with all-cause and cause-specific mortality among people with diabetes.

Methods A total of 5278 people with diabetes from the National Health and Nutrition Examination Survey 1999–2014 were included. Biological ageing was measured from different perspectives, including phenotypic age, biological age, telomere length and klotho concentration. Phenotypic/biological age acceleration was the residual resulting from a linear model when regressing phenotypic/biological age on chronological age. Cox proportional hazards models were used to examine the relationships between ageing and all-cause, cardiovascular disease (CVD), and cancer mortality.

Results Over median follow-up for 7.3 years, 1355 diabetics died. There was a positive and linear association of mortality with phenotypic age acceleration (HRall-cause 1.04; HRCVD 1.04; HRcancer 1.04, p<0.001) and biological age acceleration (HRall-cause 1.03; HRCVD 1.04; HRcancer 1.03, p<0.001). Telomere length was inversely associated with all-cause mortality (tertile (T)3 vs T1: HR 0.67, p<0.05). The concentration of klotho had a U-shaped relationship with mortality (T2 vs T1: HRall-cause 0.62; HRCVD 0.48; HRcancer 0.47, p<0.05). Further, stratified analysis by age and sex found that the associations of ageing-related markers with mortality were more significant in the aged and female subgroup.

Conclusions Biological ageing was positively associated with mortality among people with diabetes, indicating therapies targeting antiageing could be encouraged to halt the progression of diabetes.

  • aging
  • death
  • diabetes mellitus

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors LC and XY: formal analysis, methodology, writing—original draft, writing—review and editing. YZ: writing—review and editing. HC: writing—review and editing, validation. TT: formal analysis. PY: data curation, methodology, funding acquisition. YT: resources, funding acquisition, project administration, writing—review and editing;YT is responsible for the overall content as guarantor.

  • Funding This study was supported by the National Key Research and Development Project (2018YFC1604000).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.