The study examined the association between diabetes, HbA1c, and cancer risk in the UK Biobank, using data from 476,517 participants (54% women), followed for an average period of 7.1 years. Diabetes was defined on the basis of baseline self-reported diagnosis of diabetes and/or use of diabetes medication, while HbA1c measured at baseline was categorized as low (<31 mmol/mol), normal (31-<39 mmol/mol), increased risk (39-<48 mmol/mol), and high risk for diabetes (≥48 mmol/mol). Multivariable Cox proportional hazards models were used to estimate the association of diabetes and cancer at different anatomical sites, with adjustment for cancer-specific risk factors.
The study found that diabetes was associated with increased risk of cancers of the stomach, liver, bladder, endometrium, and lung among smokers, and with decreased risk of prostate cancer. Compared with the normal HbA1c category, the increased risk category was positively associated with risk of cancers of the colon, liver, bladder, and lung among smokers, and the high-risk category was associated with increased risk of cancers of the esophagus, liver, pancreas, and bladder, and with decreased risk of prostate cancer. Based on the study results the authors suggested that both diabetes and/or elevated HbA1c are associated with risk of cancer at several anatomic sites.
The association of type 2 diabetes and HbA1c with subsequent risk of cancer at different anatomical sites
Many studies have examined a possible link between type 2 diabetes and the occurrence of cancer of different types. Associations between diabetes and cancers of the breast, colorectum, pancreas, ovary, endometrium, bladder, kidney, and other sites have been reported. However, a recent critical review found that only a minority of these associations were supported by robust evidence. Furthermore, few studies have examined the association of HbA1c, a blood marker of glucose levels over the past 1 to 3 months, and cancer risk. There is a need for additional large epidemiologic studies using HbA1c to predict cancer, both among diabetics and in the general population. We propose to examine: 1) the association of type 2 diabetes or prescribed anti-diabetes medication with cancer occurring at different sites; 2) the association of HbA1c levels with cancer at the sites of interest in participants with and without a history of diabetes at baseline; and 3) the association of blood glucose level and cancer risk. The following cancers will be included: breast, endometrium, ovary, oesophagus, stomach, pancreas, liver, bladder, kidney, prostate, thyroid, melanoma, brain/glioma, meningioma, leukaemia, diffuse non-Hodgkins lymphoma, multiple myeloma, and lung.
|Lead investigator:||Dr Thomas Rohan|
|Lead institution:||Albert Einstein College of Medicine|