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Cancer increases risk for subsequent diabetes
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Cancer increased patients’ risk for subsequently developing diabetes, according to results of a cohort study conducted in South Korea.
“Chronic comorbidities, including diabetes, are key determinants of quality of life in cancer,” Juhee Cho, PhD, associate professor at Sungkyunkwan University in Seoul, and colleagues wrote. “Diabetes, a major risk factor of cardiovascular disease, is the main cause of noncancer mortality among cancer survivors and is associated with increased mortality in patients with cancer. [Although] multiple studies have established that diabetes is a risk factor for the development of several types of cancer and a prognostic factor for cancer-related mortality, a limited body of evidence suggests that cancer can increase the risk of developing new cases of diabetes, especially after pancreatic, colorectal and breast cancer.”
The researchers performed a cohort study of 524,089 Korean individuals aged 20 to 70 years. The cohort had no history of cancer or diabetes, and they underwent observation for up to 10 years from 2003 to 2013.
Incident cancer served as an exposure, and the main outcome was incident type 2 diabetes following cancer as determined by insurance claim codes.
Over a median 7 years of follow-up for 494,189 individuals (mean age, 41.8 years; 50% women), 15,130 patients developed cancer and 26,610 developed diabetes.
Of those who developed diabetes, 834 patients had previously been diagnosed with cancer (incident rate, 17.4 per 1,000 person-years).
Cancer appeared associated with an increased risk for subsequent diabetes after adjustment for age, sex, precancer diabetes risk factors, metabolic factors and comorbidities (HR = 1.35; 95% CI, 1.26-1.45).
Diabetes risk appeared highest the first 2 years following cancer diagnosis. However, it remained elevated throughout the follow-up period.
Pancreatic cancer had the strongest association with diabetes (HR = 5.15; 95% CI, 3.32-7.99), followed by kidney (HR = 2.06; 95% CI, 1.34-3.16), liver (HR = 1.95; 95% CI, 1.5-2.54), gall bladder (HR = 1.79; 95% CI, 1.08-2.98), lung (HR = 1.74; 95% CI, 1.34-2.24), blood (HR = 1.61; 95% CI, 1.07-2.43), breast (HR = 1.6; 95% CI, 1.27-2.01), stomach (HR = 1.35; 95% CI, 1.16-1.58) and thyroid (HR = 1.33; 95% CI, 1.12-1.59) cancers.
The study was limited by a lack of information on cancer stage, as well as by little information on treatment and outcomes derived from insurance data.
“Physicians should remember that patients with cancer develop other clinical problems, such as diabetes, with higher frequency than individuals without cancer, and should consider routine diabetes screening in these patients,” Cho and colleagues wrote. – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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