Is Insulin a potential risk for Cancer ? – Health Files by Md. Wasim Ghori – ETHealthWorld

Health

Diabetes and Cancer are common diseases having a tremendous impact on health globally. It has been reported that patients with diabetes have an excess risk of cancer by 20–25% compared to those without diabetes. There have been a number of studies showing an association between diabetes and cancer risk and a growing concern that this risk may be linked to insulin therapy.

Thus, are diabetes and diabetes treatments especially insulin, associated with an increased risk of cancer? These questions have been exercising the minds of the clinical community since the past publications of a series of epidemiologic studies investigated the relative risk for cancer incidence associated with the use of the basal insulin analogue, insulin glargine, or any insulin.

Specifically, there is increasing epidemiological evidence that Type 2 Diabetes Mellitus (T2DM) is associated with an increased risk of certain site-specific cancers, such as breast cancer, colorectal cancer, liver cancer and pancreatic cancer. However, the association between Type 1 Diabetes Mellitus (T1DM) and cancer remains unclear because relatively a small number of studies have investigated the risk of cancer in patients with T1DM.

However, a recent study, published in JAMA Oncology, looked at the correlation between daily insulin dose and cancer incidence among patients with T1DM. It also found that the association is stronger among those with insulin resistance.

While in the past, studies have found a higher incidence of certain cancers in T1DM compared with the general population. However, this is the first study to explore the associated cancer incidence factors in T1DM and identifies a potential mechanism to explain this association. To conduct the study, the research team analysed the associations of more than 50 common risk factors such as smoking, alcohol use, exercise, metabolic risk factors, medication use and family history with cancer incidence in 1,303 patients with T1DM whose data were collected over 28 years.

The results of this recent study showed that traditional metabolic factors such as obesity represented by body mass index, sugar control represented by d A1c and blood pressure control do not associate with cancer incidence in patients with T1DM. However, cancer incidence was higher for those who took large doses of insulin. Hazard Ratios (HRs) were significantly higher in the high-dose insulin vs low-dose insulin group, suggesting those using higher daily doses of insulin had a more than 4-fold increase in the risk of a cancer diagnosis.

Furthermore, the study also found that age and sex are associated with cancer incidence when evaluated separately and that a daily insulin dose posed a higher risk of cancer than age, especially a higher insulin dose with women more specifically found to carry a higher risk than men.

The results implied that clinicians might need to balance the potential cancer risk when treating patients with T1DM on a high daily insulin dose or that improving insulin sensitivity may be preferred than simply increasing the insulin dose.

In the meantime, in agreement with statementsissued by the major diabetes associations, there is no need to panic. Insulin has an excellent risk benefit ratio, however careful consideration of the choices available might be considered wise for patients who are at high biological risk of cancer (for example, those with family or personal history of cancer) and many of these patients will appreciate discussion of these issues if they require pharmacotherapy for diabetes. The point at which insulin initiation takes place might also be usefully reconsidered.

To conclude, diabetes, its treatments and their relationship to cancers is an area of considerable complexity. However, further research is required to determine whether these concerns and benefits are valid.

Larger studies in T1DM are needed in the future to validate this association. Nevertheless, the findings of the new study will lead to continued research in this area and potential policy changes in cancer screening and insulin dosing recommendations.

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