New-Onset Diabetes after an Obesity-Related Cancer Diagnosis and Survival Outcomes in the Women’s Health Initiative

Prasoona Karra, Sheetal Hardikar, Maci Winn, Garnet L. Anderson, Benjamin Haaland, Benjamin Krick, Cynthia A. Thomson, Aladdin Shadyab, Juhua Luo, Nazmus Saquib, Howard D. Strickler, Rowan Chlebowski, Rhonda S. Arthur, Scott A. Summers, William L. Holland, Thunder Jalili, Mary C. Playdon

Research output: Contribution to journalArticlepeer-review


Background: Individuals diagnosed with an obesity-related cancer (ORC survivors) are at an elevated risk of incident diabetes compared with cancer-free individuals, but whether this confers survival disadvantage is unknown. Methods: We assessed the rate of incident diabetes in ORC survivors and evaluated the association of incident diabetes with all-cause and cancer-specific mortality among females with ORC in the Women’s Health Initiative cohort (N = 14,651). Cox proportional hazards regression models stratified by exposure-risk periods (0–1, >1–3, >3–5, >5–7, and >7–10 years) from ORC diagnosis and time-varying exposure (diabetes) analyses were performed. Results: Among the ORC survivors, a total of 1.3% developed diabetes within ≤1 year of follow-up and 2.5%, 2.3%, 2.3%, and 3.6% at 1–3, 3–5, 5–7, and 7–10 years of follow-up, respectively, after an ORC diagnosis. The median survival for those diagnosed with diabetes within 1-year of cancer diagnosis and those with no diabetes diagnosis in that time frame was 8.8 [95% confidence interval (CI), 7.0–14.5) years and 16.6 (95% CI, 16.1–17.0) years, respectively. New-onset compared with no diabetes as a time-varying exposure was associated with higher risk of all-cause (HR, 1.27; 95% CI, 1.16–1.40) and cancer-specific (HR, 1.17; 95% CI, 0.99–1.38) mortality. When stratified by exposure-risk periods, incident diabetes in ≤1 year of follow-up was associated with higher all-cause (HR, 1.76; 95% CI, 1.40–2.20) and cancer-specific (HR0–1, 1.82; 95% CI, 1.28–2.57) mortality, compared with no diabetes diagnosis. Conclusions: Incident diabetes was associated with worse cancer-specific and all-cause survival, particularly in the year after cancer diagnosis. Impact: These findings draw attention to the importance of diabetes prevention efforts among cancer survivors to improve survival outcomes.

Original languageEnglish (US)
Pages (from-to)1356-1364
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
Issue number10
StatePublished - Oct 1 2023
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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