Increased Risk of Site-Specific Cancer in People with Type 2 Diabetes: A National Cohort Study.

Donata Linkeviciute-Ulinskiene,Giedre Smailyte,Lina Zabuliene,Rimantas Stukas,Ausvydas Patasius

doi:10.3390/ijerph17010246

Abstract

A retrospective cohort design was used with the objective to evaluate cancer risk among people with type 2 diabetes mellitus (T2DM) in Lithuania. The cohort was established by identifying all patients with the first diagnosis of T2DM in the National Health Insurance Fund database during 2000–2012. Cancer cases were identified by record linkage with the Lithuanian Cancer Registry. Standardized incidence ratios (SIRs) were calculated. Of the 127,290 people that were included, 5959 cases of cancer in men and 6661 cancer cases in women with T2DM were observed. A statistically significant increase in risk for all cancer sites was observed in women, SIR 1.16 (95% CI 1.14–1.19), but not in men, SIR 1.00 (95% CI 0.98–1.03). Among males, a significant increase of liver (SIR 2.11, 95% CI 1.79–2.49]), pancreas (SIR 1.77, 95% CI 1.57–1.99), kidney (SIR 1.46 95% CI 1.31–1.62), thyroid (SIR 1.83, 95% CI 1.32–2.54), colorectal (SIR 1.23, 95% CI 1.14–1.31]), skin melanoma (SIR 1.40, 95% CI 1.11–1.76), and non–melanoma skin (SIR 1.14, 95% CI 1.05–1.23) cancer was observed. For females with T2DM, a significant increase in risk of cancer of the liver (SIR 1.45, 95% CI 1.17–1.79), pancreas (SIR 1.74, 95% CI 1.56–1.93), kidney (SIR = 1.43, 95% CI 1.28–1.60), thyroid (SIR = 1.40, 95% CI 1.22–1.62), breast (SIR = 1.24, 95% CI 1.17–1.31), and corpus uteri (SIR 2.07, 95% CI 1.93–2.21) was observed. In conclusion, people with T2DM in Lithuania had an increased risk of site-specific cancer.

Highlights

Diabetes mellitus and cancer are complex and growing worldwide health problems, associated with severe acute and chronic complications affecting both the quality of life and survival
Significant increase in risk for overall cancer was observed in women, SIR 1.16
A meta-analysis by Song et al, 2015, found that long diabetes duration was associated with a 1.5- to 1.7-fold increased risk of pancreatic cancer [14]

Summary

Introduction

Diabetes mellitus and cancer are complex and growing worldwide health problems, associated with severe acute and chronic complications affecting both the quality of life and survival. According to the International Diabetes Federation, it is estimated that there were 425 million people with diabetes in 2017, and by 2045 the number will rise to 629 million, increasing by 48% [1]. Since the incidence of cancer and diabetes is predicted to increase in the following decades, this emphasizes the relevance of adequate prevention, early detection, and appropriate management of both diseases worldwide. A wide range of epidemiological studies on cancer and diabetes interactions have been conducted and diabetes (primarily T2DM) was shown to be associated with increased risk for some cancer sites

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