Abstract
BackgroundRaised serum glucose has been linked to increased risk of many solid cancers. We performed a meta-analysis to quantify and summarise the evidence for this link.MethodsPubmed and Embase were reviewed, using search terms representing serum glucose and cancer. Inclusion and exclusion criteria focused on epidemiological studies with clear definitions of serum glucose levels, cancer type, as well as well-described statistical methods with sufficient data available. We used 6.1 mmol/L as the cut-off for high glucose, consistent with the WHO definition of metabolic syndrome. Random effects analyses were performed to estimate the pooled relative risk (RR).ResultsNineteen studies were included in the primary analysis, which showed a pooled RR of 1.32 (95% CI: 1.20 – 1.45). Including only those individuals with fasting glucose measurements did not have a large effect on the pooled RR (1.32 (95% CI: 1.11-1.57). A stratified analysis showed a pooled RR of 1.34 (95% CI: 1.02-1.77) for hormonally driven cancer and 1.21 (95% CI: 1.09-1.36) for cancers thought to be driven by Insulin Growth Factor-1.ConclusionA positive association between serum glucose and risk of cancer was found. The underlying biological mechanisms remain to be elucidated but our subgroup analyses suggest that the insulin- IGF-1 axis does not fully explain the association. These findings are of public health importance as measures to reduce serum glucose via lifestyle and dietary changes could be implemented in the context of cancer mortality.
Highlights
Raised serum glucose has been linked to increased risk of many solid cancers
Our results showed a weaker association for Insulin growth factor −1 (IGF-1) driven cancers than the overall association or non-hormonally driven cancers, suggesting that if the insulin- insulin growth factor (IGF)- 1 axis does play a role it is likely to be as part of a more complex molecular mechanism
The direction of this study is consistent with our findings, our meta-analysis focused on high serum glucose levels as defined by the World Health Organisation (WHO) definition for metabolic syndrome so that we included potential diabetic subjects
Summary
Raised serum glucose has been linked to increased risk of many solid cancers. People with diabetes are 2-fold more likely to die from cancer than those without [1]. It is thought that pre-diagnostic elevated blood glucose levels are associated with risk of cancer [2,3,4]. The largest being a Korean cohort study of over one million men and women found a hazard ratio for all solid cancers of 1.22 (95% CI: 1.16-1.27) for men in the fifth quintile compared to the first quintile [5]. Despite the growing evidence for an association between diabetes and carcinogenesis [6], the mechanism by which raised glucose contributes to risk of cancer is not fully
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