Cancer occurrence in Danish diabetic patients: duration and insulin effects

Aims/hypothesis Cancer is more frequent among diabetes patients, but it is unknown how this excess varies with duration of diabetes and insulin use. The aim of this study was to analyse disease data to examine this issue further. Methods We linked the Danish National Diabetes Register and Cancer Reg...

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Bibliographic Details
Published in:Diabetologia 2012-04, Vol.55 (4), p.948-958
Main Authors: Carstensen, B., Witte, D. R., Friis, S.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Comorbidity
Denmark - epidemiology
Diabetes
Diabetes Mellitus - drug therapy
Diabetes Mellitus - epidemiology
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
Human Physiology
Humans
Hypoglycemic Agents - adverse effects
Hypoglycemic Agents - therapeutic use
Incidence
Insulin
Insulin - adverse effects
Insulin - therapeutic use
Internal Medicine
Male
Medical diagnosis
Medical sciences
Medicine
Medicine & Public Health
Metabolic Diseases
Middle Aged
Neoplasms - diagnosis
Neoplasms - epidemiology
Prostate cancer
Registries
Risk
Risk Factors
Skin cancer
Survival Rate
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Summary:Aims/hypothesis Cancer is more frequent among diabetes patients, but it is unknown how this excess varies with duration of diabetes and insulin use. The aim of this study was to analyse disease data to examine this issue further. Methods We linked the Danish National Diabetes Register and Cancer Registry and performed a cohort analysis of the entire Danish population by diabetes status, duration of diabetes and insulin use, comparing cancer incidence rates in diabetic patients with the non-diabetic population for the 15 year period 1995–2009, using Poisson regression with natural splines to describe the variation by duration. Results We found 20,032 cancer cases among patients not using insulin and 2,794 cancer cases among diabetic patients using insulin. The cancer incidence rate ratio among non-insulin users relative to the non-diabetic population decreased from over 2 at diagnosis to 1.15 after 2 years of diabetes duration. The cancer incidence rate ratio was higher among patients using insulin, decreasing from 5 at the start of insulin treatment to about 1.25 after 5 years of insulin use. Among non-insulin users, cancers of the stomach, colorectum, liver, pancreas, lung, corpus uteri, kidney and brain, and lymphomas were elevated. Among insulin users the rate ratio of prostate cancer was decreasing by duration whereas we found higher risk of cancer of the stomach, lung, liver, pancreas and kidney. Breast cancer incidence rates were not affected by either diabetes or insulin use. Conclusions The observed duration effects suggest that both increased surveillance for cancer in the first years after diagnosis of diabetes, and reverse causation, where undiagnosed cancers increase the likelihood of diabetes diagnosis, play a role. For longer durations, a combination of common causes for diabetes and cancer, as well as the effects of diabetes and insulin exposure per se, may play a role in the association between diabetes and some cancers.
ISSN:0012-186X
1432-0428
DOI:10.1007/s00125-011-2381-4