Trajectories of type 2 diabetes and cancer in 330 000 individuals with prediabetes: 20-year observational study in England
Authors' conclusion
The trajectories of type 2 diabetes and cancer following a diagnosis of prediabetes varied substantially by age at prediabetes diagnosis and, to a lesser extent, other sociodemographic and lifestyle factors, with most younger individuals (aged <55 years) remaining in the prediabetes state. Strategies to improve the prevention and early identification of type 2 diabetes and cancer in individuals with prediabetes should be tailored to the age at which prediabetes is diagnosed.
Study context
- Population
- Individuals aged 18–100 years with newly diagnosed prediabetes, Jan 1, 1998–Nov 30, 2018, England (Clinical Practice Research Datalink)163,782 transitions
- Participants
- 328,049 individuals
- Outcome
- Disease trajectories from prediabetes to T2D, cancer and death: state occupancy probabilities and sojourn times across eight states and seven transitions
- Follow-up
- 10 years after prediabetes diagnosis
Methodological detailsmultistate model, linked primary care, hospital and mortality records
- Multistate model
- Linked primary care, hospital and mortality records
Main finding
As reported in the abstract
- Probability of remaining in prediabetes state
- 23.2% (men aged ≥75 years) to 72.1% (men aged <55 years)
- Probability of death following prediabetes
- 1.2% (women aged <55 years) to 38.7% (women aged ≥75 years)
- Probability of developing T2D and remaining in this state
- 7.9% (men aged ≥75 years) to 24.0% (women aged <55 years)
- Probability of developing cancer and remaining in this state
- 1.9% (men aged <55 years) to 7.8% (men aged ≥65 to <75 years)
- Time spent in prediabetes state during 10 years
- 5.34 years (men aged ≥75 years) to 8.34 years (men aged <55 years)
Observational data: associations, not effects.
Further findings
Cancer incidence rates · over 10 years
- Largest excess cancer incidence with T2D vs prediabetes, women
- 4.1 more cases per 1000 person-years
- Largest excess cancer incidence with T2D vs prediabetes, men
- 4.8 more cases per 1000 person-years
- Cancer incidence greater in older individuals (aged ≥75 years at prediabetes diagnosis), in women and men
- Only marginally higher with T2D vs prediabetes
Associated factors
- BMI, smoking, socioeconomic status and ethnicity were associated with occupancy probabilities and sojourn times
Original publication
Trajectories of type 2 diabetes and cancer in 330 000 individuals with prediabetes: 20-year observational study in England. Lancet Diabetes Endocrinol. Published 19 November 2025. doi:10.
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