A historical cohort study on glycemic-control and cancer-risk among patients with diabetes

•Among 440,000 diabetic patients with over 26,000 cancer events, glycemic control had little or no association with risk of of most selected cancer.•Poorer glycemic control had a strong positive association with pancreatic cancer and a moderate negative association with prostate cancer.•Hyperglycemi...

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Published in:	Cancer epidemiology Vol. 57; pp. 104 - 109
Main Authors:	Dankner, R., Boker, L. Keinan, Boffetta, P., Balicer, R.D., Murad, H., Berlin, A., Olmer, L., Agai, N., Freedman, LS
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-12-2018 Elsevier Limited
Subjects:	Adult Aged Aged, 80 and over Bias Blood Glucose Blood glucose control Blood levels Cancer Causation Cohort Cohort analysis Cohort Studies Colon Diabetes Diabetes Complications - epidemiology Diabetes mellitus Diagnosis Epidemiology Female Glucose Glycemic-control HbA1c Health care Health risk assessment Health risks Hemoglobin Humans Liver Lungs Male Middle Aged Missing data Multiple imputation Neoplasms - complications Neoplasms - epidemiology Pancreas Pancreatic cancer Patients Population studies Proportional Hazards Models Prostate cancer Prostatic Neoplasms - epidemiology Risk Risk management Smoking Social Class Socioeconomic factors Socioeconomics Time dependence Young Adult Israel Missing data Cohort Risk Blood glucose control Multiple imputation HbA1c Glycemic-control Cancer
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Summary:	•Among 440,000 diabetic patients with over 26,000 cancer events, glycemic control had little or no association with risk of of most selected cancer.•Poorer glycemic control had a strong positive association with pancreatic cancer and a moderate negative association with prostate cancer.•Hyperglycemia does not appear to provide the main explanation for the generally raised cancer risk among people with diabetes. Aims: This population-based historical cohort study examined whether poor glycemic-control (i.e., high glucose and HbA1c blood levels) in patients with diabetes is associated with cancer-risk. Methods: From a large healthcare database, patients aged 21–89 years, diagnosed with diabetes before January 2002 (prevalent) or during 2002–2010 (incident), were followed for cancer during 2004–2012 (excluding cancers diagnosed within the first 2 years since diabetes diagnosis). Risks of selected cancers (all-sites, colon, breast, lung, prostate, pancreas and liver) were estimated according to glycemic-control in a Cox regression model with time-dependent covariates, adjusted for age, sex, ethnic origin, socioeconomic status, smoking and parity. Missing glucose or HbA1c values were imputed. Results: Among 440,000 patients included in our analysis, cancer was detected more than 2 years after diabetes diagnosis in 26,887 patients (6%) during the follow-up period. Associations of poor glycemic-control with all-sites cancer and most specific cancers were either null or only weak (hazard ratios (HRs) for a 1% HbA1c or a 30 mg/dl glucose increase between 0.94 and 1.09). Exceptions were pancreatic cancer, for which there was a strong positive association (HRs: 1.26–1.51), and prostate cancer, for which there was a moderate negative association (HRs: 0.85–0.96). Conclusion: Overall, poor glycemic-control appears to be only weakly associated with cancer-risk, if at all. A substantial part of the positive association with pancreatic cancer is attributable to reverse causation, with the cancer causing poorer glycemic-control prior to its diagnosis. The negative association with prostate cancer may be related to lower PSA levels in those with poor control.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1877-7821 1877-783X
DOI:	10.1016/j.canep.2018.10.010