Diabetes mellitus and risk of bladder cancer: a meta-analysis of cohort studies
Zhu Z, Zhang X, Shen Z, Zhong S, Wang X, Lu Y, Xu C. PLoS One. 2013;8(2):e56662. doi: 10.1371/journal.pone.0056662. Epub 2013 Feb 20.


Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.



Increasing evidence suggests that diabetes mellitus (DM) may be associated with an increased risk of bladder cancer. To provide a quantitative assessment of this association, we evaluated the relation between DM and incidence and mortality of bladder cancer in an updated meta-analysis of cohort studies. Methods We identified cohort studies by searching the EMBASE and MEDLINE databases, through 31 March 2012. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with random-effects models.


A total of 29 cohort studies (27 articles) were included in this meta-analysis. DM was associated with an increased incidence of bladder cancer (RR 1.29, 95% CI: 1.08-1.54), with significant evidence of heterogeneity among these studies (p<0.001, I(2) = 94.9%). In stratified analysis, the RRs of bladder cancer were 1.36 (1.05-1.77) for diabetic men and 1.28 (0.75-2.19) for diabetic women, respectively. DM was also positively associated with bladder cancer mortality (RR 1.33, 95% CI: 1.14-1.55), with evident heterogeneity between studies (p = 0.002, I(2) = 63.3%). The positive association was observed for both men (RR 1.54, 95% CI: 1.30-1.82) and women (RR 1.50, 95% CI: 1.05-2.14).


These findings suggest that compared to non-diabetic individuals, diabetic individuals have an increased incidence and mortality of bladder cancer.