ORIGINAL ARTICLE Association between type 2 diabetes and cancer incidence in Taiwan: data from a prospective community-based cohort study Wei-Sin Yang 1 • Pei-Chun Chen 2 • Hung-Ju Lin 3 • Ta-Chen Su 3 • Hsiu-Ching Hsu 3 • Ming-Fong Chen 3 • Yuan-Teh Lee 3 • Kuo-Liong Chien 1,3 Received: 4 October 2016 / Accepted: 18 January 2017 Ó Springer-Verlag Italia 2017 Abstract Aims Evidence of a role for type 2 diabetes in overall cancer risk and risk for specific types of cancer is limited in ethnic Chinese populations. We therefore investigated whether there is an association between diabetes and can- cer incidence in Taiwan. Methods This study recruited a total of 3602 adults aged 35 years or over (average 54.9 ± 12.3 years, 52.8% women). Participants with fasting glucose C126 mg/dL, or taking hypoglycemic medications, were classed as having type 2 diabetes. Cancer incidence was established through regular follow-up interviews and medical records. Cox proportional hazard regression models were used to examine associations for diabetes with risk of all-cause and site-specific cancers. Results During a median of follow-up of 10.5 years, 275 individuals developed cancer, including 157 digestive cancers and 31 urinary cancers. Younger participants (aged \ 55 years) with diabetes had a greater risk of all cancers [adjusted relative risk (RR) 3.42; 95% confidence interval (CI), 1.78–6.57], digestive cancers (adjusted RR 2.88; 95% CI 1.15–6.94) and urinary cancers (adjusted RR 13.4; 95% CI 2.70–66.3) compared with individuals in the same age group without diabetes. Conclusions Our results clearly demonstrate that middle- aged individuals of Chinese ethnicity with diabetes have a greater risk of all-cause cancer and specific subtypes of cancer. Keywords Cohort study Á Type 2 diabetes Á Cancer Introduction According to the World Health Organization (WHO), cancer is one of the leading causes of death worldwide and accounted for 8.2 million deaths in 2012. Of note, 60% of new cases worldwide occurred in Asia [1]. In Taiwan, cancer has been the leading cause of death. Diabetes mel- litus is a well-known and serious health issue worldwide. The WHO stated that the worldwide prevalence was 171 million in 2000, which is estimated to increase to approxi- mately 366 million by 2030 [2]. Type 2 diabetes has become an important public health issue in the Chinese population living in mainland China, Hong Kong, Taiwan and Singa- pore, which is at least one-fifth of the global population [3]. Although the older diabetes population has been more of a concern, cancer incidence in younger adults has significantly increased. While the association between diabetes and can- cer has been investigated in previous studies, data in Asian populations are scarce [4–12]. Therefore, based on a prospective community-based adult cohort, our aim was to establish whether there is an association between diabetes and cancer in Chinese people. We also sought to identify whether an association exists between diabetes and cancer specifically in the younger Chinese population. Managed by Massimo Federici. Electronic supplementary material The online version of this article (doi:10.1007/s00592-017-0966-1) contains supplementary material, which is available to authorized users. & Kuo-Liong Chien klchien@ntu.edu.tw 1 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan 2 Department of Public Health, China Medical University, Taichung, Taiwan 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 123 Acta Diabetol DOI 10.1007/s00592-017-0966-1