Diabetes mellitus and risk of gastric cancer: a systematic review and meta-analysis of observational studies

Eur J Gastroenterol Hepatol. 2011 Nov;23(12):1127-35. doi: 10.1097/MEG.0b013e32834b8d73.


Aim: Increasing evidence suggests that a history of diabetes may be involved in the development of various sites of cancer. However, the association of diabetes and risk of gastric cancer (GC) remains unclear.

Methods: We identified studies by a literature search of MEDLINE (from 1 January 1966), Web of Science (from 1 January 1994), and EMBASE (from 1 January 1974 through 31 May 2011), and by searching the reference lists of pertinent articles. All data were extracted independently by two investigators using a standardized data abstraction tool. Summary relative risks (SRRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Between-study heterogeneity was assessed using the Cochran's Q and I statistics.

Results: A total of 21 studies (four case-control studies, 17 cohort studies) were included in this meta-analysis. Analysis of these 21 studies found that compared with nondiabetic individuals, diabetic individuals had a similar risk of GC (SRRs, 1.09; 95% CI: 0.98-1.22). There was strong evidence of heterogeneity among these studies (P<0.001, I²=81.2%). A subgrouped analysis found that diabetic women had 18% increased risk of GC (SRRs, 1.18; 95% CI: 1.01-1.39), whereas it was not the case with diabetic men. No significant public bias was found in this study.

Conclusion: These findings of this systematic review indicate that compared with nondiabetic individuals, diabetic women have an 18% increased risk of GC development. However, diabetic men have a similar risk of GC.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diabetes Complications / epidemiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Publication Bias
  • Risk Assessment / methods
  • Sex Factors
  • Stomach Neoplasms / epidemiology*