People with type 2 diabetes are twice as likely to die from some cancers compared with the general population, according to a recent study, which found that the condition increased the risk of dying from from pancreatic, bowel or liver cancers.
Women with type 2 diabetes also face a higher risk of dying from endometrial cancer, found the researchers, whose study has been published in the journal Diabetologia.
A team from the University of Leicester said cancer risk should be given “a similar level of attention” as other complications of type 2 diabetes, such as the increased risk of heart disease.
The Independent reports that the study, funded by charity Hope Against Cancer, also showed that women with type 2 diabetes had a 9% increased risk of dying from breast cancer – and the risk appeared to be increasing.
The scientists suggested it could be beneficial to extend breast cancer screening so that younger women with type 2 diabetes could be screened.
The team examined data on 137 804 people in the UK with type 2 diabetes with an average age of 64 and tracked them for 8.4 years.
During the follow-up period, more than 39 000 people involved with the study died.
Across the period studied – 1998 to 2018 – researchers analysed trends in mortality among those in the study and compared them with people in the general population.
They found that cancer death rates among people with type 2 diabetes aged 55 and 65 decreased slightly during the study period. But they increased among people aged 75 and 85.
The authors wrote: “Our findings underline the growing cancer burden in people with type 2 diabetes, particularly in older individuals, and highlight the need to prioritise cancer prevention, research and early detection and management in this population, especially for colorectal, pancreatic, liver and endometrial cancer, whose mortality rates were substantially higher in individuals with type 2 diabetes than in the general population.”
Dr Lucy Chambers, head of research communications at Diabetes UK, said: “If you’re living with type 2 diabetes, over time, high blood glucose, blood pressure and blood fat levels can cause serious long-term damage to the body, including to the eyes, heart, nerves and kidneys.
“Type 2 diabetes is also linked to increased risk of developing certain types of cancer, and both conditions can have common risk factors.
“This research indicates that while people with type 2 diabetes in the UK tend to be living longer, deaths from some type of cancers appear to be increasing, particularly in older people with type 2 diabetes.
“These findings highlight the need for further research into cancer causes and prevention in this population.”
Study details
Inequalities in cancer mortality trends in people with type 2 diabetes: 20 year population-based study in England
Suping Ling, Francesco Zaccardi, Eyad Issa, Melanie J. Davies, Kamlesh Khunti & Karen Brown
Published in Diabetologia on 24 January 2023
Abstract
Aims/hypothesis
The aim of this study was to describe the long-term trends in cancer mortality rates in people with type 2 diabetes based on subgroups defined by sociodemographic characteristics and risk factors.
Methods
We defined a cohort of individuals aged ≥35 years who had newly diagnosed type 2 diabetes in the Clinical Practice Research Datalink between 1 January 1998 and 30 November 2018. We assessed trends in all-cause, all-cancer and cancer-specific mortality rates by age, gender, ethnicity, socioeconomic status, obesity and smoking status. We used Poisson regression to calculate age- and calendar year-specific mortality rates and Joinpoint regression to assess trends for each outcome. We estimated standardised mortality ratios comparing mortality rates in people with type 2 diabetes with those in the general population.
Results
Among 137,804 individuals, during a median follow-up of 8.4 years, all-cause mortality rates decreased at all ages between 1998 and 2018; cancer mortality rates also decreased for 55- and 65-year-olds but increased for 75- and 85-year-olds, with average annual percentage changes (AAPCs) of –1.4% (95% CI –1.5, –1.3), –0.2% (–0.3, –0.1), 1.2% (0.8, 1.6) and 1.6% (1.5, 1.7), respectively. Higher AAPCs were observed in women than men (1.5% vs 0.5%), in the least deprived than the most deprived (1.5% vs 1.0%) and in people with morbid obesity than those with normal body weight (5.8% vs 0.7%), although all these stratified subgroups showed upward trends in cancer mortality rates. Increasing cancer mortality rates were also observed in people of White ethnicity and former/current smokers, but downward trends were observed in other ethnic groups and non-smokers. These results have led to persistent inequalities by gender and deprivation but widening disparities by smoking status. Constant upward trends in mortality rates were also observed for pancreatic, liver and lung cancer at all ages, colorectal cancer at most ages, breast cancer at younger ages, and prostate and endometrial cancer at older ages. Compared with the general population, people with type 2 diabetes had a more than 1.5-fold increased risk of colorectal, pancreatic, liver and endometrial cancer mortality during the whole study period.
Conclusions/interpretation
In contrast to the declines in all-cause mortality rates at all ages, the cancer burden has increased in older people with type 2 diabetes, especially for colorectal, pancreatic, liver and endometrial cancer. Tailored cancer prevention and early detection strategies are needed to address persistent inequalities in the older population, the most deprived and smokers.
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