Health

New study shows increased cancer mortality in people with type 2 diabetes


Diabetes

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New research published on diabetes showed a significantly higher rate of cancer mortality in people with type 2 diabetes than in the general population, 18% for all cancers combined, 9% for breast cancer and 2.4 times for colorectal cancer. Cancer mortality rates among people with diabetes are also twice that of the general population for diabetes-related cancers including liver (both sexes), pancreas (both sexes), and pancreatic (both sexes) cancers. bisexual) and endometrial cancer (women only).

Research by Dr Suping Ling, Leicester Real World Evidence Unit, Leicester Diabetes Research Centre, University of Leicester, and London School of Hygiene & Tropical Medicine, UK, also found breast widening. cancer death rate interest rate 4.1%/year in young woman had type 2 diabetes during the 20-year study period from 1998 to 2018.

Accumulating epidemiological evidence has suggested a higher risk of morbidity and mortality for certain types of cancer in people with type 2 diabetes, with prolonged exposure to the effects of blood sugar and blood sugar levels. Increased insulin, insulin resistance, and chronic inflammation are the underlying biological mechanisms.

The evidence strongly indicates that there is a causal relationship between type 2 diabetes and the pancreas, liver and endometrial cancer. While previous studies have extensively investigated inequality in cardiovascular outcomes Among people with type 2 diabetes, less is known about whether such inequalities exist in cancer death rate.

In this study, the authors used a cohort of individuals 35 years of age and older who were newly diagnosed with type 2 diabetes in the Clinical Practice Research Database, a common practice database. of the United Kingdom, over a 20-year period from 1 January 1998 to 30 November 2018 They analyzed trends in all-cause, all-cancer and cancer-specific mortality rates. by age, sex, ethnicity, socioeconomic status, obesity and smoking status. They also estimated standardized mortality, comparing mortality rates among people with type 2 diabetes to that of the general population.

The study included 137,804 individuals with newly diagnosed type 2 diabetes with a median follow-up of 8.4 years. The authors found that all-cause mortality decreased at all ages from 1998 to 2018; cancer mortality (all cancers combined except non-melanoma skin cancer) also decreased among 55-year-olds (1.4% per year) and 65-year-olds (0.2%) per year) but increased in 75-year-olds (up 1.2%/year) and 85-year-olds (increasing by 1.6%/year).

The authors say that the reduction in cardiovascular mortality observed in older age groups due to successful prevention and treatment of cardiovascular disease over the past few decades, means that people live longer and are more likely to have other diseases and therefore die from other causes (including cancer). ). However, screening for diabetes, better management of diabetes and its complications, earlier cancer detection, and improved cancer treatments appear to have benefited. young people with T2D in a similar way as they have in the general population.

Cancer mortality was also higher in women (1.5%) than in men (1.0%), although women had lower rates of cancer death throughout the study period. . Biological factors, health-seeking behaviors, and lifestyle factors such as smoking and obesity all differ between men and women, but each factor’s relative contribution to cancer mortality is still unknown. The least deprived/richest quintile also had higher AAPCs (1.5%) than the most deprived/poorest (1.0%)—leading to a narrow but persistent gap by economic status society.

Other important findings included a higher AAPC cancer mortality rate for people with obesity (5.8%) than for people in other weight categories (all less than 1.0). %) and the AAPC cancer mortality rate for whites (2.4%) was higher than the 3.4% average annual percentage reduction among non-white ethnicities combined. The gap in cancer mortality between smokers and non-smokers also widened, with smokers seeing an increase in AAPC cancer death rates to 3.4%, while non-smokers AAPC smoking decreased by 1.4%.

The authors suggest that current health care policies and structures may benefit never-smokers more than smokers — and tailored interventions for smokers. Drugs as specific screening programs can help address the increasing rates of cancer mortality (and all-cause mortality) among smokers.

A continued upward trend in mortality was also observed for pancreatic, liver and lung cancers of all ages. colorectal cancer At most ages, breast cancer is younger, and prostate and endometrial cancer is older.

Compared with the general population, people with type 2 diabetes were 1.5 times more likely to die from colorectal, pancreatic, liver, and endometrial cancers over the entire study period. Although national reports during this period showed a moral decline in breast cancer at younger ages in this study, this new study also shows an increasing rate of breast cancer mortality. 4.1% increase per year in young women with type 2 diabetes.

From this perspective, our results suggest that it may be useful to expand breast cancer screening to young women with type 2 diabetes. However, due to the high cost, the authors suggest: and the potential for longer exposure to screening procedures, cost-effectiveness analysis is needed to determine the appropriate time window and identify subgroups that may benefit more.”

They added that there are currently trials investigating the expansion of the existing breast cancer screening window from 50-70 years to 47-73 years in the general population; In addition, women with a family history of breast cancer or a specific gene mutation should be screened at a young age, but there are no current guidelines that specifically look at the increased risk of breast cancer. breast letter. breast cancer in women with diabetes.

Regarding overall cancer mortality among people with diabetes, the authors said: “Prevention of cardiovascular disease was and still is considered a top priority in people with diabetes. Our results challenge this view by showing that cancer may have overtaken cardiovascular disease as a leading cause of death in people with type 2 diabetes. Therefore, prevention strategies Cancer prevention should be at least as important as cardiovascular disease prevention, especially in the elderly, and for certain cancers such as liver, colorectal and Pancreatic Cancer. Appropriate interventions should also be considered for smokers, whose cancer mortality rates are higher and steadily increasing. Interventions for smokers, in addition to stopping smoking, can include campaigns to raise cancer awareness and improve early detection. For people with type 2 diabetes, early cancer detection through changes to existing screening programs or more intensive investigation of suspected/nonspecific cancer symptoms can reduce number of avoidable cancer deaths.”

In summary, our findings highlight the increasing burden of cancer in people with type 2 diabetes, especially in older adults, and highlight the need for Prioritize cancer prevention, research and early detection and management in this population, especially for colorectal, pancreatic, liver and endometrial cancers, which have a higher mortality rate significantly in people with type 2 Diabetes than in general population.”

More information:
Suping Ling et al., Inequality in cancer mortality trends among people with type 2 diabetes: A 20-year population-based study in the UK, diabetes (2023). DOI: 10.1007/s00125-022-05854-8

quote: New study showing increased cancer mortality in people with type 2 diabetes (2023, January 24) retrieved January 24, 2023 from https://medicalxpress.com/ news/2023-01-Cancer-mortality-people-diabetes.html

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