Higher risk of death from cancer seen in type 2 diabetics

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A large new observational study from the University of Leicester has found that cancer mortality in people with type 2 diabetes is substantially higher than in the general population. The increase was 18% for all cancers combined, 9% for breast cancer and 2.4 times for colorectal cancer. Notably, breast cancer mortality increased by 4.1% per year among younger women with type 2 diabetes.

People with diabetes also had about twice the death rate of the general population from diabetes-related cancers, including cancers of the liver, pancreas and endometrium.

The authors said: “Our findings highlight the increasing burden of cancer in people with type 2 diabetes, particularly in older individuals, and highlight the need to prioritize cancer prevention, research and early detection and treatment in this population, especially for colorectal cancer. , pancreatic, liver and endometrial cancer, whose mortality rates were substantially higher in individuals with type 2 diabetes than in the general population”.

The research was based on data from the Clinical Practice Research Datalink (CPRD) and looked at a 20-year period from 1998 to 2018. The team’s work was published in Diabetes. The lead author was Suping Ling, PhD, Leicester Diabetes Research Centre, University of Leicester and London School of Hygiene & Tropical Medicine.

Accumulating epidemiological evidence shows that people with type 2 diabetes are at increased risk of incidence and mortality from some types of cancer. Prolonged exposure to the effects of increased blood sugar and insulin levels, insulin resistance and chronic inflammation are all potential underlying biological mechanisms. And there is new evidence of a biological link, the protein prostasin, between diabetes and cancer.

Robust evidence indicates a causal relationship between type 2 diabetes and pancreatic, liver, and endometrial cancer. But little is known, in general, about inequalities in cancer death rates of diabetics.

In this study, the authors used the CPRD to identify a cohort of individuals aged 35 years and older who were recently diagnosed with type 2 diabetes. CPRD is a UK general practice database. The researchers analyzed trends in all-cause, all-cancer, and cancer-specific mortality rates by age, sex, ethnicity, socioeconomic status, obesity, and smoking. They also estimated standardized death rates by comparing death rates in people with type 2 diabetes with the general population.

The study included 137,804 subjects with a median follow-up of 8.4 years. The authors found that all-cause death rates declined at all ages during the study period, likely due to successful cardiovascular prevention and treatment, meaning people live longer now and are more likely to experience other conditions. . However, they note that diabetes screening, better management of diabetes and its complications, earlier cancer detection, and better cancer treatments appear to have benefited younger people with type 2 diabetes.

There were also greater ‘mean annual percentage changes’ (AAPC – the average percentage increase/decrease per year) in cancer mortality in women (1.5%) compared to men (1.0%) and greater cancer mortality AAPC for morbidly obese people (5.8%) versus those in other weight categories (all under 1.0%). The difference in cancer mortality between smokers and non-smokers has also increased, and these authors suggest that current health policies and structures could benefit never-smokers more than smokers.

Steady upward trends in mortality rates were also observed for pancreatic, liver, and lung cancer at all ages, colorectal cancer at most ages, breast cancer at younger ages, and prostate and endometrial cancer at older ages.

Higher risk of death from cancer seen in type 2 diabetics

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