Prospective study of cancer in Japanese patients with type 2 diabetes: the Fukuoka Diabetes Registry

Abstract

Background Although the association between type 2 diabetes and cancer has been reported, few epidemiological studies have been conducted in Japanese patients whose leading cause of death is cancer. We prospectively studied the incidence of site-specific cancer, risk factors for developing cancer, cancer death, and survival in Japanese patients with type 2 diabetes. Methods We followed 4923 participants (mean age, 65 years) with type 2 diabetes attending an outpatient diabetes clinic for a median of 5.3 years (follow-up rate, 99.0%). Results During the follow-up period, cancer occurred in 450 participants (incidence rate, 22.3/1000 person-years in men and 12.2/1000 person-years in women). In men, prostate cancer was the most common cancer (4.3/1000 person-years), colorectal cancer was the second (3.6/1000 person-years), and gastric cancer was the third (3.3/1000 person-years). In women, colorectal cancer was the most common cancer (2.6/1000 person-years), gastric cancer was the second (2.0/1000 person-years), and breast cancer was the third (1.4/1000 person-years). Smoking, male sex, low-density lipoprotein cholesterol, family history of cancer, and reduced intake of isoflavone daidzein were significant risk factors for developing cancer using multivariable Cox proportional hazards models. The leading cancer death was lung cancer in men and pancreatic cancer in women. The survival was the best for prostate cancer and the worst for pancreatic cancer (2-year cancer-specific survival 95.4%, 30.0%, respectively). Conclusions Since the leading cause of death in patients with type 2 diabetes is cancer in Japan, clinicians should be aware of epidemiological data regarding cancer besides diabetic complications.

T2DM may exert a protective effect against digestive system tumors in East Asian populations: a Mendelian randomization analysis

“…The potential mechanisms underlying the link between T2DM and cancer include hyperglycemia, insulin resistance, high insulin levels and increased insulin-like growth factor I (IGF-1) levels, etc ( 29 ). Smoking, male gender and low-density lipoprotein cholesterol (LDL-C)<100mg/dl were found to be risk factors for diabetic patients to develop cancer, while body mass index (BMI), alcohol consumption and HbA1C levels were not associated with cancer occurrence in diabetic population ( 30 ). A prospective case-control study in Korea showed that higher blood glucose levels, lower high-density lipoprotein cholesterol (HDL-C) and homeostasis model assessment of insulin resistance (HOMA-IR) levels were associated with the risk of early stage gastric cancer ( 31 ).…”

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“…The potential mechanisms underlying the link between T2DM and cancer include hyperglycemia, insulin resistance, high insulin levels and increased insulin-like growth factor I (IGF-1) levels, etc (29). Smoking, male gender and low-density lipoprotein cholesterol (LDL-C)<100mg/dl were found to be risk factors for diabetic patients to develop cancer, while body mass index (BMI), alcohol consumption and HbA1C levels were not associated with cancer occurrence in diabetic population (30). A prospective casecontrol study in Korea showed that higher blood glucose levels, lower high-density lipoprotein cholesterol (HDL-C) and homeostasis model assessment of insulin resistance (HOMA-IR) levels were associated with the risk of early stage gastric cancer (31).…”

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“…The potential mechanisms underlying the link between T2DM and cancer include hyperglycemia, insulin resistance, high insulin levels and increased insulin-like growth factor I (IGF-1) levels, etc (29). Smoking, male gender and low-density lipoprotein cholesterol (LDL-C)<100mg/dl were found to be risk factors for diabetic patients to develop cancer, while body mass index (BMI), alcohol consumption and HbA1C levels were not associated with cancer occurrence in diabetic population (30). A prospective casecontrol study in Korea showed that higher blood glucose levels, lower high-density lipoprotein cholesterol (HDL-C) and homeostasis model assessment of insulin resistance (HOMA-IR) levels were associated with the risk of early stage gastric cancer (31).…”