Abstract
Objectives This study was conducted to evaluate the effect of insulin resistance and insulin-like growth factor-1 (IGF-1) on the prevalance and the prognosis of cancer in type 2 diabetic patients detected by clinical examination and laboratory investigations. Background Diabetes and obesity are emerging as avoidable causes of cancer mortality. Many biological mechanisms link obesity and diabetes to cancer development through direct or indirect effects of obesity on insulin and IGF-1, sex hormones, adipokines, and inflammation. The activation of these mechanisms promotes an environment of increased proliferation, inhibited apoptosis, and increased genomic instability. Patients and methods Patients were categorized into three groups 'diabetic patients with cancer, diabetic patients without cancer, and nondiabetic patients with cancer'. They underwent evaluation in the form of thorough history taking, complete physical examination including anthropometric measurement, laboratory investigations including the fasting insulin level and C-peptide to detect insulin resistance by calculating the homeostasis model assessment of insulin resistance (HOMA-IR), the serum lipid profile, and serum IGF-1 by the enzyme-linked immunosorbent assay test. Results Results show a higher serum level of IGF-1, a higher fasting insulin and C-peptide and HOMA-IR among diabetic patients with cancer compared with nondiabetic patients with cancer. Diabetic patients with cancer (group I) had a significantly higher fasting insulin, fasting blood glucose, and HOMA-IR than nondiabetic patients with cancer (group II), who had a higher fasting insulin, fasting blood glucose, and HOMA-IR than diabetic patients without cancer (group III). Group I had a significantly higher C-peptide and IGF-1 than group III; group I had a significantly higher C-peptide than group II, whereas group II had a significantly higher IGF-1 than group III. This means that the presence of high insulin resistance and a high level of serum IGF-1 increase the incidence of cancer in diabetic patients. Conclusion The present study reported a profound effect of diabetes mellitus and insulin resistance on the incidence and the severity of cancer in type 2 diabetic patients. Diabetic patients with cancer had a significantly higher IGF-1 and HOMA-IR, and higher markers of insulin sensitivity, elevated glucose, elevated triglycerides, elevated low-density lipoprotein, and low high-density lipoprotein, compared with diabetic patients without cancer.
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