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Association between Gastroenterological Malignancy and Diabetes Mellitus and Anti-Diabetic Therapy: A Nationwide, Population-Based Cohort Study.
PLoS One. 2015; 10(5):e0125421.Plos

Abstract

BACKGROUND

The relationship between diabetes mellitus (DM) and cancer incidence has been evaluated in limited kinds of cancer. The effect of anti-diabetic therapy (ADT) on carcinogenesis among diabetic patients is also unclear.

MATERIALS AND METHODS

Using population-based representative insurance claims data in Taiwan, 36,270 DM patients and 145,080 comparison subjects without DM were identified from claims from 2005 to 2010. The association between the top ten leading causes of cancer-related death in Taiwan and DM was evaluated. Whether ADT altered the risk of developing cancer was also investigated.

RESULTS

Incidence of cancer at any site was significantly higher in patients with DM than in those without (p<0.001). The risk of carcinogenesis imparted by DM was greatest in gastroenterological malignancies (liver, pancreas, and colorectal cancer) as well as lung, breast and oral cancer (p<0.001). Among the oral types of ADT, metformin decreased the risk of lung and liver cancer, but had less effect on reducing the risk of colorectal cancer. α-glucosidase inhibitor decreased the risk of developing liver, colorectal, and breast cancer. Apart from intermediate-acting insulin, rapid-acting, long-acting, and combination insulin treatment significantly reduced the overall cancer risk among all DM patients. In subgroup analysis, long-acting insulin treatment significantly decreased the risk of lung, liver, and colorectal cancer.

CONCLUSION

Our results supported the notion that pre-existing DM increases the incidence of gastroenterological cancer. ADT, especially metformin, α-glucosidase inhibitor, and long-acting insulin treatment, may protect patients with DM against these malignancies. It is crucial that oncologists should closely collaborate with endocrinologists to provide an optimal cancer-specific therapy and diabetic treatment to patients simultaneously with cancer and DM.

Authors+Show Affiliations

Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25978841

Citation

Lin, Chien-Ming, et al. "Association Between Gastroenterological Malignancy and Diabetes Mellitus and Anti-Diabetic Therapy: a Nationwide, Population-Based Cohort Study." PloS One, vol. 10, no. 5, 2015, pp. e0125421.
Lin CM, Huang HL, Chu FY, et al. Association between Gastroenterological Malignancy and Diabetes Mellitus and Anti-Diabetic Therapy: A Nationwide, Population-Based Cohort Study. PLoS One. 2015;10(5):e0125421.
Lin, C. M., Huang, H. L., Chu, F. Y., Fan, H. C., Chen, H. A., Chu, D. M., Wu, L. W., Wang, C. C., Chen, W. L., Lin, S. H., & Ho, S. Y. (2015). Association between Gastroenterological Malignancy and Diabetes Mellitus and Anti-Diabetic Therapy: A Nationwide, Population-Based Cohort Study. PloS One, 10(5), e0125421. https://doi.org/10.1371/journal.pone.0125421
Lin CM, et al. Association Between Gastroenterological Malignancy and Diabetes Mellitus and Anti-Diabetic Therapy: a Nationwide, Population-Based Cohort Study. PLoS One. 2015;10(5):e0125421. PubMed PMID: 25978841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Gastroenterological Malignancy and Diabetes Mellitus and Anti-Diabetic Therapy: A Nationwide, Population-Based Cohort Study. AU - Lin,Chien-Ming, AU - Huang,Hui-Ling, AU - Chu,Fang-Ying, AU - Fan,Hueng-Chuen, AU - Chen,Hung-An, AU - Chu,Der-Ming, AU - Wu,Li-Wei, AU - Wang,Chung-Ching, AU - Chen,Wei-Liang, AU - Lin,Shih-Hua, AU - Ho,Shinn-Ying, Y1 - 2015/05/15/ PY - 2014/11/25/received PY - 2015/03/23/accepted PY - 2015/5/16/entrez PY - 2015/5/16/pubmed PY - 2016/3/5/medline SP - e0125421 EP - e0125421 JF - PloS one JO - PLoS One VL - 10 IS - 5 N2 - BACKGROUND: The relationship between diabetes mellitus (DM) and cancer incidence has been evaluated in limited kinds of cancer. The effect of anti-diabetic therapy (ADT) on carcinogenesis among diabetic patients is also unclear. MATERIALS AND METHODS: Using population-based representative insurance claims data in Taiwan, 36,270 DM patients and 145,080 comparison subjects without DM were identified from claims from 2005 to 2010. The association between the top ten leading causes of cancer-related death in Taiwan and DM was evaluated. Whether ADT altered the risk of developing cancer was also investigated. RESULTS: Incidence of cancer at any site was significantly higher in patients with DM than in those without (p<0.001). The risk of carcinogenesis imparted by DM was greatest in gastroenterological malignancies (liver, pancreas, and colorectal cancer) as well as lung, breast and oral cancer (p<0.001). Among the oral types of ADT, metformin decreased the risk of lung and liver cancer, but had less effect on reducing the risk of colorectal cancer. α-glucosidase inhibitor decreased the risk of developing liver, colorectal, and breast cancer. Apart from intermediate-acting insulin, rapid-acting, long-acting, and combination insulin treatment significantly reduced the overall cancer risk among all DM patients. In subgroup analysis, long-acting insulin treatment significantly decreased the risk of lung, liver, and colorectal cancer. CONCLUSION: Our results supported the notion that pre-existing DM increases the incidence of gastroenterological cancer. ADT, especially metformin, α-glucosidase inhibitor, and long-acting insulin treatment, may protect patients with DM against these malignancies. It is crucial that oncologists should closely collaborate with endocrinologists to provide an optimal cancer-specific therapy and diabetic treatment to patients simultaneously with cancer and DM. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25978841/Association_between_Gastroenterological_Malignancy_and_Diabetes_Mellitus_and_Anti_Diabetic_Therapy:_A_Nationwide_Population_Based_Cohort_Study_ L2 - https://dx.plos.org/10.1371/journal.pone.0125421 DB - PRIME DP - Unbound Medicine ER -