Abstract
We examined changing patterns in cancer incidence and deaths in diabetes compared to the background population. A total of 457,473 patients with type 2 diabetes, included between 1998 and 2014, were matched on age, sex, and county to five controls from the population. Incidence, trends in incidence and post-cancer mortality for cancer were estimated with Cox regression and standardised incidence rates. Causes of death were estimated using logistic regression. Relative importance of risk factors was estimated using Heller’s relative importance model. Type 2 diabetes had a higher risk for all cancer, HR 1.10 (95% CI 1.09–1.12), with highest HRs for liver (3.31), pancreas (2.19) and uterine cancer (1.78). There were lesser increases in risk for breast (1.05) and colorectal cancers (1.20). Type 2 diabetes patients experienced a higher HR 1.23 (1.21–1.25) of overall post-cancer mortality and mortality from prostate, breast, and colorectal cancers. By the year 2030 cancer could become the most common cause of death in type 2 diabetes. Persons with type 2 diabetes are at greater risk of developing cancer and lower chance of surviving it. Notably, hazards for specific cancers (e.g. liver, pancreas) in type 2 patients cannot be explained by obesity alone.
Highlights
We examined changing patterns in cancer incidence and deaths in diabetes compared to the background population
We evaluated (1) time trends in causes of death, (2) incidence of all cancer and site-specific cancers, (3) time-trends in cancer incidence and (4) post-cancer mortality among patients with type 2 diabetes compared to matched controls from the general population
Type 2 diabetes was defined by the epidemiologic definition: “Patients of all ages receiving only dietary treatment, or oral glucose-lowering agents only, or persons diagnosed after the age of 40 years receiving insulin therapy or insulin and oral glucose-lowering agents”
Summary
We examined changing patterns in cancer incidence and deaths in diabetes compared to the background population. A growing body of evidence demonstrates that type 2 diabetes confers an increased risk of total cancer and site-specific cancers and that it may affect prognosis[4,5,6,7,8,9,10,11,12,13]. With cancer being a more common cause of death and both incidence and prevalence of diabetes increasing w orldwide[3,21,22], the association between these two outcomes might make the burden of these diseases a substantial global health challenge. We evaluated (1) time trends in causes of death, (2) incidence of all cancer and site-specific cancers, (3) time-trends in cancer incidence and (4) post-cancer mortality among patients with type 2 diabetes compared to matched controls from the general population. We evaluated the ability of routine risk factors to predict cancer incidence for type 2 diabetes, using one of the world’s largest diabetes databases
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