Abstract
BackgroundThe risk of several types of cancer is increased in type 2 diabetes mellitus. The earliest possible diagnosis of cancer – difficult within regular outpatient diabetes care - is of utmost importance for patients’ survival. The aim of this multicenter, retrospective (years 1998–2015), case-control study was to identify risk factors associated with malignancy in subjects with diabetes treated in a typical outpatient setting.MethodsIn the databases of 3 diabetic and 1 primary care clinics 203 patients (115 women) with type 2 diabetes mellitus who developed malignancy while treated for diabetes were identified. The control group consisted of 203 strictly age- and gender matched subjects with type 2 diabetes without cancer. Factors associated with diabetes: disease duration, antidiabetic medications use and metabolic control of diabetes were analyzed. Also other variables: BMI (body mass index), smoking habits, place of residence and comorbidities were included into analysis.ResultsThe most prevalent malignancies in men and women together were breast cancer (20.7 %) and colorectal cancer (16.3 %). HbA1c (hemoglobin A1c) level ≥8.5 %, obesity and insulin treatment in dose-dependent and time-varying manner demonstrated significant association with increased risk of malignancy, while metformin use was associated with a lower risk of cancer. Diabetes duration, comorbidities, smoking habits, place of residence and aspirin use did not show significant association with risk of malignancy.ConclusionsIn the outpatient setting the obese patients with poorly controlled insulin treated type 2 diabetes mellitus should be rigorously assessed towards malignancies, particularly breast cancer in women and colorectal cancer in men.
Highlights
The risk of several types of cancer is increased in type 2 diabetes mellitus
Metformin is considered to play a protective role in cancer development and outcomes [17], whilst exogenous insulin use seems to be associated with an elevated cancer risk [18]
Since the earliest possible diagnosis of cancer is of utmost importance for patients’ survival, identification of clinically relevant risk factors of cancer among diabetic patients may be helpful in identifying subjects at greater risk of malignancy
Summary
In the databases of 3 diabetic and 1 primary care clinics 203 patients (115 women) with type 2 diabetes mellitus who developed malignancy while treated for diabetes were identified. The control group consisted of 203 strictly age- and gender matched subjects with type 2 diabetes without cancer. After Bioethics Committee approval, we performed retrospective analysis of existing individual patients’ records in the databases of 3 diabetic and 1 primary care clinics. Inclusion criteria for the ‘case’ group included: cancer diagnosed after diagnosis of type 2 diabetes, at least one HbA1c measurement before or at the time of cancer diagnosis, date of diabetes diagnosis, diabetes treatment, BMI and history of comorbidities available. The control group consisted of 203 strictly age- and gender matched subjects with T2DM without cancer. Data for the ‘control’ subjects were assessed from the same index time, i.e., if the ‘case’ patient had cancer diagnosed in April 2009, the data for his/her comparator were taken from the same period
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