Diabetes mellitus is associated with an increased risk of gastric cancer: a cohort study

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 23; no. 3; pp. 382 - 390
• Main Authors: Yang, Hyo-Joon, Kang, Danbee, Chang, Yoosoo, Ahn, Jiin, Ryu, Seungho, Cho, Juhee, Guallar, Eliseo, Sohn, Chong Il
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-05-2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Antidiabetics; Atrophy; Cancer Research; Cancer screening; Cohort analysis; Diabetes; Diabetes mellitus; Diabetes Mellitus - physiopathology; Endoscopy; Female; Follow-Up Studies; Gastric cancer; Gastroenterology; Gastroscopy; Humans; Incidence; Intestine; Male; Medical screening; Medicine; Medicine & Public Health; Metaplasia; Middle Aged; Mucosa; Oncology; Original Article; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Stomach Neoplasms - epidemiology; Stomach Neoplasms - etiology; Surgical Oncology; Republic of Korea; Gastroscopy; Gastric cancer; Diabetes mellitus; Stomach neoplasms; Cohort studies
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-019-01033-8

Background
Diabetes mellitus (DM) has been considered a potential risk factor for gastric cancer, but the evidence is conflicting. We evaluated the association of DM with incident gastric cancer in a large cohort of men and women with endoscopic assessment at baseline and during follow-up.
Methods
We performed a retrospective cohort study of 195,312 adult men and women who underwent upper endoscopy at baseline and during follow-up between 2003 and 2014. DM was defined as fasting serum glucose ≥ 126 mg/dL, self-reported history of DM or current use of antidiabetic medications. Gastric cancer was confirmed histologically.
Results
The prevalence of DM at baseline was 3.0% (
n
 = 5774). Over 865,511 person-years of follow-up, 198 participants developed gastric cancer. The fully adjusted hazard ratio (HR) for incident gastric cancer comparing participants with and without DM at baseline was 1.76 [95% confidence interval (CI) 1.04–2.97;
P
 = 0.033). When we evaluated DM as a time-varying covariate, the fully adjusted HR was 1.66 (95% CI 1.04–2.68;
P
 = 0.036). The association between DM and incident gastric cancer did not differ by the presence of intestinal metaplasia (
P
for interaction = 0.61).
Conclusions
In this large cohort with endoscopic follow-up, DM was independently associated with increased gastric cancer incidence. The increased risk was independent of mucosal atrophy and intestinal metaplasia and was consistent in participants with newly developed DM during follow-up. Patients with DM may require more intensive endoscopic follow-up for gastric cancer screening.