Diabetes and Cancer

In 2009 there was a publication in the journal Diabetologia suggesting patients on one particular type of insulin may be at a higher risk of developing malignancy when compared to other treatments.

This was a highly controversial study, initially from a German group, that studied over one hundred thousand German patients on various treatments.  The European Association for the Study of Diabetes (EASD) commissioned four other studies to look at this whole topic and all of the studies were published in one edition of the European journal Diabetologia.  The studies have achieved great notoriety and there is huge controversy about the results, what has become very clear is that there is an association between type II diabetes and an increased risk for a whole range of different malignancies and this whole topic has become the focus for much activity and debate. 

Professor Russell-Jones was asked by the EASD to present during their annual conference in Vienna, at a symposium on diabetes and cancer and this was the highest and largest attended symposium in the EASD’s history with over 5000 people in the auditorium and 3000 in the spillover.  His presentation was quoted by both Bloomberg and Reuters.  Since then Professor Russell-Jones has given similar invited lectures at a number of the worlds largest meetings in Argentina, Milan, Prague, Stockholm, Belgium and Denmark.

There is overwhelming evidence suggesting that patients with type II diabetes have a higher risk of most solid tumours and malignancies but interestingly, seem to have a lower rate of prostate cancer.  Treatment with insulin secretagoguesor insulin appears to increase the risk and Metformin seems to protect or partially protect if on insulin or insulin secretagogues.  In addition, it is known that patients who are overweight have a higher risk of malignancy and when non diabetic they also have higher insulin levels thus raising the possibility that insulin may, in part, play a role.  Achieving good diabetes control is the overwhelming aim for clinical care and this must be a priority as patients are much more likely to die of cardiovascular disease if good control is not maintained.  There has been significant controversy as to whether insulin Glagine has a higher risk of malignancy and this is due to its known higher IGF-1 binding, which is a growth factor.  Other long acting insulins, both Insulatard and Detemir, have binding to IGF-1 that is similar to human insulin.  What we do not know however, is the relevance of the high binding of Glagine as there is much controvesy as to whether Glagine is associated with a higher risk or not.

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