Diabetes and Cancer

Diabetes and Cancer

Epidemiologic data have demonstrated significant increases of various cancers in people with obesity and diabetes. Recently, concern has emerged that antihyperglycemic medications may also be associated with an increased prevalence of multiple cancers; however, available data are limited and conflicting.1,2

Increased body mass index (BMI) is associated with an increased risk of multiple cancers based on observational epidemiological data. Higher BMIs are also closely associated with increased levels of endogenous insulin, insulin-like growth factors, inflammatory cytokines, and other factors that can have downstream pro-cancer growth effects.

The role of hyperglycemia in cancer development is less clear, but an association cannot be ruled out, as current observational data suggest an increased cancer risk in people with diabetes. Because of a lack of data from large-scale, randomized studies, there is currently insufficient evidence that antihyperglycemic medications are associated with an increased risk of cancer. Similarly, evidence showing a positive impact of antihyperglycemic medications on cancer development is also lacking. Clinicians can continue to confidently prescribe all FDA- approved antihyperglycemic medications for the management of hyperglycemia according to established practice guidelines. In patients who have an elevated cancer risk or positive family history of cancer, the cautious selection of antihyperglycemic medications is both prudent and warranted. The AACE additionally advocates for the improved treatment and management of obesity, early cancer screening in patients at increased risk, increased research collaboration, and improved study designs to address outstanding concerns surrounding the diabetes-cancer relationship.1

References

  1. Handelsman Y, Leroith D, Bloomgarden ZT, et al. Diabetes and cancer—an AACE/ACE consensus statement. Endocr Pract. 2013;19:675-693.
  2. Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33:1674-1685.