Carron Meney, Shalini Bhola and Andrew Collier*
Department of Diabetes, University Hospital, UKFulltext PDF
The typical adult diagnosed with type 2 diabetes at age 60 loses approximately 5 years of their life. This excess mortality was previously considered to be primarily due to cardiovascular disease. Aggressive strategies targeting cardiovascular risk factors have been successful in reducing mortality. A recent study demonstrated that cancer is now the commonest cause of death in patients with type 2 diabetes. Multiple studies have shown a link between obesity, malignancy and cancer mortality. Diabetes has been associated with the incidence of breast, endometrial, pancreatic and colorectal cancer plus increased cancer-related mortality independent of obesity. Hyperinsulinemia leads to the production of pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor-alpha which increases the dysregulation of many metabolic pathways, further increasing the inflammatory response, drives tumor growth and inhibits apoptosis. There is considerable evidence that cancer patients with diabetes are treated less aggressively or receive modified anticancer treatment compared with cancer patients without diabetes. Studies also report that people with diabetes have a more advanced stage of cancer at diagnosis, poorer response to treatment and increased risk of treatment-related adverse effects and increased short-term mortality. It has been suggested that oral glucose-lowering medications and insulin treatment may have an impact on cancer risk. Further studies need to be undertaken to investigate the mechanism of obesity compared with type 2 diabetes in the development of specific malignancies. In addition, should screening for cancer be part of the management of type 2 diabetes?
Obesity; Type 2 diabetes; Cancer; Hyperinsulinemia
Meney C, Bhola S, Collier A. Obesity, Type 2 Diabetes and Cancer: Where we are now?. Clin Oncol. 2020;5:1756..