The Association Between Type 2 Diabetes And Risk Of Cancer:Based On The Medical Insurance Database

Diabetes mellitus and cancer are both serious public health issues around the world.However,studies focus on the relationship between type 2 diabetes mellitus(T2DM),antidiabetic agents and risk of cancer among the Chinese population are still scarce.This retrospective study aimed to explore the relationship between diabetes mellitus,use of antidiabetic agents(biguanides,sulfonylureas,thiazolidinediones,alpha-glucosidase inhibitors and insulin)and the risk of overall and 21 site-specific cancers,based on the Tianjin Urban Employee Basic Medical Insurance(UEBMI)database(2003-2014).Risk of overall and all common site-specific cancers were estimated using incidence rate,incidence rate ratio,Kaplan-Meier curve,and Cox proportional hazards model,considering the detection bias,reverse causality,time-related bias and other measurable confounding factors.The risk of overall cancer among T2DM population was 57%-60%higher than that of the general population.Being male and aged between 50-69 years were found to be associated with higher risk of cancer among T2DM patients.Compared to the general population,the risk of liver,colorectal,gastric cancer were significantly higher among T2DM patients,while no significant difference was found in terms of the risk of breast,bladder,thyroid,prostate,uterine,esophageal,ovarian,gallbladder,brain,skin,cervical cancer,leukemia/myeloma,and non-Hodgkin's lymphoma.Patients with longer diabetes duration had higher risk of pancreatic cancer,and female diabetic patients had higher risk of developing kideney and bladder cancer.No association was found between the use of antidiabetic agents and cancer risk.T2DM is an independent risk factor of cancer development.The cental government should strengthen the primary prevention among people under high risk of T2DM and patients with pre-diabetes,aiming to reduce the incidence of both T2DM and cancer.Regular screening of liver,colorectal,gastric,and pancreatic cancer should be promoted to enforce early diagnosis and treatment.Efficient diabetes management and cancer prevention and control system should be constructed and strengthened.Long-term prospective studies focus on the role of diabetes duration,and RCT studies exploring the relationship between different class and generic antidiabetic agents with different cumulative duration and dosage in this topic are warranted.