The literature on the association between diabetes severity and cancer risk is limited and inconclusive. The study aimed to evaluate the association between the adapted Diabetes Complications Severity Index (aDCSI) and the duration of type 2 diabetes and cancer risk.


Patients ages 20 years or older with newly diagnosed type 2 diabetes between January 1, 2007, and December 31, 2011, were identified from Taiwan National Health Insurance claims data. Standardized incidence ratios (SIR) were calculated to compare cancer incidence in people with diabetes with that in the general population. Poisson regression was used to examine whether SIRs differed by age, sex, aDSCI, and duration of diabetes.


A total of 756,547 patients were included, with a median follow-up of 8.8 years. Excluding the first year after diagnosis, the SIR for overall cancer was 1.18 [95% confidence interval (CI) 1.17–1.19]. Higher aDCSI was associated with increased SIRs for overall [SIR ratio 1.03 (1.02–1.03) per point increase], head and neck (1.03; 1.01–1.04), liver (1.04; 1.03–1.05), pancreas (1.03; 1.00–1.05), kidney (1.13; 1.10–1.15), and leukemia (1.09; 1.06–1.13). There was no association between aDCSI and colorectal, extrahepatic biliary tract, uterus and thyroid cancer, and a negative association with breast cancer (0.97; 0.95–0.98). Type 2 diabetes duration was associated with increased SIRs for overall [1.01 (1.00–1.02) per year increase], head and neck (1.03; 1.01–1.05), and liver cancer (1.04; 1.02–1.05).


The heterogeneity in the association between diabetes severity and diabetes-related cancers suggests diverse underlying connections.


Adopting distinct approaches in further research and prevention strategies for different kinds of diabetes-related cancers is important.

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