Increased risk of gastrointestinal malignancy in patients with diabetes mellitus and correlations with Anti-Diabetes drugs

A nationwide population-based study in Taiwan

Chun Chih Chiu, Chin Chou Huang, Yu Chun Chen, Tzeng Ji Chen, Ying Liang, Shing Jong Lin, Jaw Wen Chen, Hsin Bang Leu, Wan Leong Chan

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective Although the major cause of morbidity and mortality in patients with diabetes mellitus (DM) is cardiovascular disease, DM is also associated with certain site-specific cancers. However, whether DM is associated with an increased risk of cancer of the digestive tract remains undetermined. A nationwide, population-based database in Taiwan was analyzed to explore the relationship between DM and cancer of the digestive organs. Methods From 2000 to 2007, a study cohort consisting of 39,515 patients with newly diagnosed diabetes without a previous diagnosis of gastrointestinal (GI) cancer was identified from the National Health Insurance Research Database in Taiwan. A control cohort of 79,030 age- and sex-matched non-diabetic subjects was selected to compare the occurrence of GI malignancies between the two groups. The association between the incidence of GI cancers and the use of glucose-lowering therapies was also investigated. Results During the 7-year follow-up period, GI cancers developed in 929 diabetic patients (2.35%) and 1,126 subjects (1.42%) in the comparison cohort. DM was associated with a 2.75-fold (95% confidence interval (CI), 2.51-3.02) higher risk of developing GI malignancy. Among GI cancers, the incidences of stomach (adjusted hazard ratio (HR), 1.49; 95% CI, 1.16-1.92), liver (adjusted HR, 2.65; 95% CI, 2.29-3.07), colon (adjusted HR, 1.58; 95% CI, 1.28-1.94) and pancreatic cancers (adjusted HR, 4.35; 95% CI, 2.93-6.47) were significantly increased in the patients with DM. An analysis of the effects of various glucose-lowering therapies in the diabetic patients revealed the use of α-glucosidase inhibitors to be associated with a lower risk of hepatic cancer (adjusted HR, 0.62; 95% CI, 0.4-0.94). Thiazolidinedione (TZD) treatment was associated with lower stomach (adjusted HR, 0.11; 95% CI, 0.02-0.82) and hepatic cancer risks (adjusted HR, 0.46; 95% CI, 0.29-0.73), while sulfonylurea use was associated with a lower colon cancer risk (adjusted HR, 0.74; 95% CI, 0.51-1.09) and a higher pancreatic cancer risk (adjusted HR, 2.36; 95% CI, 1.21-4.61). Conclusion Patients with DM have an increased risk of GI malignancy that may be affected by the use of different categories of glucose-lowering therapies.

Original languageEnglish
Pages (from-to)939-946
Number of pages8
JournalInternal Medicine
Volume52
Issue number9
DOIs
Publication statusPublished - May 1 2013
Externally publishedYes

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Taiwan
Diabetes Mellitus
Confidence Intervals
Gastrointestinal Neoplasms
Pharmaceutical Preparations
Population
Neoplasms
Liver Neoplasms
Pancreatic Neoplasms
Glucose
Databases
Glucosidases
Incidence
National Health Programs
Therapeutics
Colonic Neoplasms
Stomach Neoplasms
Gastrointestinal Tract
Stomach
Colon

Keywords

  • Diabetes mellitus
  • Gastrointestinal malignancy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Increased risk of gastrointestinal malignancy in patients with diabetes mellitus and correlations with Anti-Diabetes drugs : A nationwide population-based study in Taiwan. / Chiu, Chun Chih; Huang, Chin Chou; Chen, Yu Chun; Chen, Tzeng Ji; Liang, Ying; Lin, Shing Jong; Chen, Jaw Wen; Leu, Hsin Bang; Chan, Wan Leong.

In: Internal Medicine, Vol. 52, No. 9, 01.05.2013, p. 939-946.

Research output: Contribution to journalArticle

Chiu, Chun Chih ; Huang, Chin Chou ; Chen, Yu Chun ; Chen, Tzeng Ji ; Liang, Ying ; Lin, Shing Jong ; Chen, Jaw Wen ; Leu, Hsin Bang ; Chan, Wan Leong. / Increased risk of gastrointestinal malignancy in patients with diabetes mellitus and correlations with Anti-Diabetes drugs : A nationwide population-based study in Taiwan. In: Internal Medicine. 2013 ; Vol. 52, No. 9. pp. 939-946.
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title = "Increased risk of gastrointestinal malignancy in patients with diabetes mellitus and correlations with Anti-Diabetes drugs: A nationwide population-based study in Taiwan",
abstract = "Objective Although the major cause of morbidity and mortality in patients with diabetes mellitus (DM) is cardiovascular disease, DM is also associated with certain site-specific cancers. However, whether DM is associated with an increased risk of cancer of the digestive tract remains undetermined. A nationwide, population-based database in Taiwan was analyzed to explore the relationship between DM and cancer of the digestive organs. Methods From 2000 to 2007, a study cohort consisting of 39,515 patients with newly diagnosed diabetes without a previous diagnosis of gastrointestinal (GI) cancer was identified from the National Health Insurance Research Database in Taiwan. A control cohort of 79,030 age- and sex-matched non-diabetic subjects was selected to compare the occurrence of GI malignancies between the two groups. The association between the incidence of GI cancers and the use of glucose-lowering therapies was also investigated. Results During the 7-year follow-up period, GI cancers developed in 929 diabetic patients (2.35{\%}) and 1,126 subjects (1.42{\%}) in the comparison cohort. DM was associated with a 2.75-fold (95{\%} confidence interval (CI), 2.51-3.02) higher risk of developing GI malignancy. Among GI cancers, the incidences of stomach (adjusted hazard ratio (HR), 1.49; 95{\%} CI, 1.16-1.92), liver (adjusted HR, 2.65; 95{\%} CI, 2.29-3.07), colon (adjusted HR, 1.58; 95{\%} CI, 1.28-1.94) and pancreatic cancers (adjusted HR, 4.35; 95{\%} CI, 2.93-6.47) were significantly increased in the patients with DM. An analysis of the effects of various glucose-lowering therapies in the diabetic patients revealed the use of α-glucosidase inhibitors to be associated with a lower risk of hepatic cancer (adjusted HR, 0.62; 95{\%} CI, 0.4-0.94). Thiazolidinedione (TZD) treatment was associated with lower stomach (adjusted HR, 0.11; 95{\%} CI, 0.02-0.82) and hepatic cancer risks (adjusted HR, 0.46; 95{\%} CI, 0.29-0.73), while sulfonylurea use was associated with a lower colon cancer risk (adjusted HR, 0.74; 95{\%} CI, 0.51-1.09) and a higher pancreatic cancer risk (adjusted HR, 2.36; 95{\%} CI, 1.21-4.61). Conclusion Patients with DM have an increased risk of GI malignancy that may be affected by the use of different categories of glucose-lowering therapies.",
keywords = "Diabetes mellitus, Gastrointestinal malignancy",
author = "Chiu, {Chun Chih} and Huang, {Chin Chou} and Chen, {Yu Chun} and Chen, {Tzeng Ji} and Ying Liang and Lin, {Shing Jong} and Chen, {Jaw Wen} and Leu, {Hsin Bang} and Chan, {Wan Leong}",
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T1 - Increased risk of gastrointestinal malignancy in patients with diabetes mellitus and correlations with Anti-Diabetes drugs

T2 - A nationwide population-based study in Taiwan

AU - Chiu, Chun Chih

AU - Huang, Chin Chou

AU - Chen, Yu Chun

AU - Chen, Tzeng Ji

AU - Liang, Ying

AU - Lin, Shing Jong

AU - Chen, Jaw Wen

AU - Leu, Hsin Bang

AU - Chan, Wan Leong

PY - 2013/5/1

Y1 - 2013/5/1

N2 - Objective Although the major cause of morbidity and mortality in patients with diabetes mellitus (DM) is cardiovascular disease, DM is also associated with certain site-specific cancers. However, whether DM is associated with an increased risk of cancer of the digestive tract remains undetermined. A nationwide, population-based database in Taiwan was analyzed to explore the relationship between DM and cancer of the digestive organs. Methods From 2000 to 2007, a study cohort consisting of 39,515 patients with newly diagnosed diabetes without a previous diagnosis of gastrointestinal (GI) cancer was identified from the National Health Insurance Research Database in Taiwan. A control cohort of 79,030 age- and sex-matched non-diabetic subjects was selected to compare the occurrence of GI malignancies between the two groups. The association between the incidence of GI cancers and the use of glucose-lowering therapies was also investigated. Results During the 7-year follow-up period, GI cancers developed in 929 diabetic patients (2.35%) and 1,126 subjects (1.42%) in the comparison cohort. DM was associated with a 2.75-fold (95% confidence interval (CI), 2.51-3.02) higher risk of developing GI malignancy. Among GI cancers, the incidences of stomach (adjusted hazard ratio (HR), 1.49; 95% CI, 1.16-1.92), liver (adjusted HR, 2.65; 95% CI, 2.29-3.07), colon (adjusted HR, 1.58; 95% CI, 1.28-1.94) and pancreatic cancers (adjusted HR, 4.35; 95% CI, 2.93-6.47) were significantly increased in the patients with DM. An analysis of the effects of various glucose-lowering therapies in the diabetic patients revealed the use of α-glucosidase inhibitors to be associated with a lower risk of hepatic cancer (adjusted HR, 0.62; 95% CI, 0.4-0.94). Thiazolidinedione (TZD) treatment was associated with lower stomach (adjusted HR, 0.11; 95% CI, 0.02-0.82) and hepatic cancer risks (adjusted HR, 0.46; 95% CI, 0.29-0.73), while sulfonylurea use was associated with a lower colon cancer risk (adjusted HR, 0.74; 95% CI, 0.51-1.09) and a higher pancreatic cancer risk (adjusted HR, 2.36; 95% CI, 1.21-4.61). Conclusion Patients with DM have an increased risk of GI malignancy that may be affected by the use of different categories of glucose-lowering therapies.

AB - Objective Although the major cause of morbidity and mortality in patients with diabetes mellitus (DM) is cardiovascular disease, DM is also associated with certain site-specific cancers. However, whether DM is associated with an increased risk of cancer of the digestive tract remains undetermined. A nationwide, population-based database in Taiwan was analyzed to explore the relationship between DM and cancer of the digestive organs. Methods From 2000 to 2007, a study cohort consisting of 39,515 patients with newly diagnosed diabetes without a previous diagnosis of gastrointestinal (GI) cancer was identified from the National Health Insurance Research Database in Taiwan. A control cohort of 79,030 age- and sex-matched non-diabetic subjects was selected to compare the occurrence of GI malignancies between the two groups. The association between the incidence of GI cancers and the use of glucose-lowering therapies was also investigated. Results During the 7-year follow-up period, GI cancers developed in 929 diabetic patients (2.35%) and 1,126 subjects (1.42%) in the comparison cohort. DM was associated with a 2.75-fold (95% confidence interval (CI), 2.51-3.02) higher risk of developing GI malignancy. Among GI cancers, the incidences of stomach (adjusted hazard ratio (HR), 1.49; 95% CI, 1.16-1.92), liver (adjusted HR, 2.65; 95% CI, 2.29-3.07), colon (adjusted HR, 1.58; 95% CI, 1.28-1.94) and pancreatic cancers (adjusted HR, 4.35; 95% CI, 2.93-6.47) were significantly increased in the patients with DM. An analysis of the effects of various glucose-lowering therapies in the diabetic patients revealed the use of α-glucosidase inhibitors to be associated with a lower risk of hepatic cancer (adjusted HR, 0.62; 95% CI, 0.4-0.94). Thiazolidinedione (TZD) treatment was associated with lower stomach (adjusted HR, 0.11; 95% CI, 0.02-0.82) and hepatic cancer risks (adjusted HR, 0.46; 95% CI, 0.29-0.73), while sulfonylurea use was associated with a lower colon cancer risk (adjusted HR, 0.74; 95% CI, 0.51-1.09) and a higher pancreatic cancer risk (adjusted HR, 2.36; 95% CI, 1.21-4.61). Conclusion Patients with DM have an increased risk of GI malignancy that may be affected by the use of different categories of glucose-lowering therapies.

KW - Diabetes mellitus

KW - Gastrointestinal malignancy

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