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Diabetes mellitus is commonly classified as type 1 and type 2, and the latter type is often discussed for its morbidity and association with cancer. DM is a common cause of non-cancer-related deaths among cancer patients. Ensuring optimal blood glucose during cancer treatment could potentially improve health outcomes.
Type 2 diabetes among the general population in India1:
Association of Diabetes and cancer prevalence estimates by the International diabetes federation (IDF) among 20-79 yrs in India indicate the morbidity was 8.9% in 2019. 1 out of 7 diabetic adults worldwide reside in India, and 1 out of 3 households has diabetic patients. ~57% of adults with diabetes are undiagnosed in India. During 2019, diabetes estimates among >65 yrs is 12.1%. NFHS-5 (2019-21) estimates diabetes prevalence among >15 years as 16.1%.
Diabetes leading to cancer:
The biological link between the association of diabetes and cancer includes the role of hyperinsulinemia, hyperglycemia, chronic inflammation, and shared risk factors such as obesity. Type 2 diabetes mellitus (DM) is an independent risk factor for certain types of cancer: hepatic, pancreatic, endometrial, colorectal, bladder, and breast. However, evidence indicates a lower likelihood of prostate cancer among men with type 2 DM, which is attributed to the reduced levels of circulating testosterone.
The epidemiological pointers2 include the increased likelihood of diabetic adults developing cancer than their non-diabetic counterparts, particularly pancreatic cancer. Diabetic adults are more likely to die of cancer than their non-diabetic counterparts. Diabetes is associated with greater cancer-specific case fatality for adults with cancer, particularly colorectal cancer. In cancer patients, co-morbid diabetes has higher all-cause mortality than those without diabetes.
Available evidence3 indicates that the risk of developing cancer is high by 27% among diabetic women and 19% among diabetic men when compared with their healthy counterparts. This risk of liver cancer is 12% higher among diabetic men than diabetic women. When compared to diabetic men, diabetic women have a higher risk of developing: 15% for leukemia, 14% for stomach cancer, 13% for oral cancer, and 11% for kidney cancer.
Hence, it is important to periodically screen diabetes patients for incidence of cancer (age appropriately), and vice-versa monitor the blood glucose level of cancer patients on or after completed treatment.
Reference:
1. Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J Ophthalmol. 2021;69(11): 2932-38.
2. Olatunde A, Nigam M, Singh R.K et al. Cancer and diabetes: the interlinking metabolic pathways and repurposing actions of antidiabetic drugs. Cancer cell line. 2021;21:499.
3. Cancer and diabetes: The connections are in your DNA. Available at: https://www.cancercenter.com/ community/blog/2021/05/diabetes-cancer, last accessed on 14/3/24.
