New Delhi: Epidemiological studies suggest associations between diabetes mellitus and some cancers. The risk of several cancers appears to be increased in diabetes mellitus. On the other hand, some cancer and cancer therapies could lead to diabetes mellitus. Genetic factors, obesity, inflammation, oxidative stress, hyperglycemia, hyperinsulinemia, cancer therapies, insulin, and some oral hypoglycemic drugs appear to play a role in the crosstalk between diabetes mellitus and cancers.
In an interaction with News9Live, Dr Indoo Ammbulkar – Director- Medical Oncology – HCG Cancer Center, Borivali, explained the connection between diabetes and cancer.
The link between diabetes and cancer has been proposed for more than 100 years. The risk of cancers appears to be increased in both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Cancer was also reported to be the second most common cause of death for people with T1DM. On the other hand, approximately 8%-18% of patients with cancer have diabetes. Further, previous studies have suggested that diabetes is associated with an increased risk of cancer mortality. However, the underlying mechanisms between various types of diabetes and cancers have not yet been summarised.
Cancer incidence of liver, pancreas, kidney, esophagus, stomach, lung, thyroid, squamous cell carcinoma, and leukaemia significantly increased for both sexes with T1DM. A comprehensive meta-analysis has concluded that the presence of T2DM is associated with approximately a 10% increase in the risk of developing cancer. Previous studies have provided substantial evidence of associations between T2DM and risks of cancer in the hepatocellular, biliary tract, gallbladder, pancreas, gastrointestinal, kidney, bladder, lung, thyroid, breast, ovarian, endometrial, oral, leukemia, glioma, and melanoma. Among them, the highest risks have been demonstrated for colorectal cancer, hepatocellular cancer, or pancreatic cancer.
Most chemotherapeutic agents result in the cell cycle or cellular DNA damage thus leading to apoptosis disproportionately in rapidly dividing cells. Several studies reported that patients who received chemotherapy such as Tegafur-uracil (UFT), paclitaxel, or interferon-alpha had developed fulminant T1DM or autoimmune-mediated T1DM.
Glucocorticoids are a commonly used treatment for cancers of blood system.Additionally, they are used to treat cancer pain, chemotherapy-induced side-effects such as nausea and vomiting, and cancer-related cachexia.Furthermore, they have an ancillary role in treatment of inflammatory complications of cancer therapy and autoimmune conditions of immunomodulatory therapies.Steroid-induced diabetes mellitus has been recognized as a complication of glucocorticoid use for over 50 years.
Mammalian target of rapamycin (mTOR) inhibitors have been used for multiple types of cancer such as breast cancer and renal cell carcinoma. Data from clinical trials suggested that treatment with mTOR inhibitors was associated with a high incidence of hyperglycemia and new-onset diabetes, ranging from 13% to 50%
Cancer immunotherapies, including immune checkpoint inhibitors, adoptive cell therapy, oncolytic viruses, and cancer vaccines, manipulate the immune system to recognize and attack cancer cells. These therapies have the potential to lead to toxicity profiles for the endocrine system. For instance, insulin-dependent diabetes has been reported in patients treated with anti-programmed cell death protein 1 (PD-1) or anti-programmed cell death ligand-1 (PDL-1) antibodies. The prevalence of diabetes was estimated at 0.4%-0.9% in this population.
There is a complicated association between diabetes mellitus and cancers. In summary, the risk of a number of cancers and cancer mortality is increased in T1DM and T2DM. On the other hand, some kinds of cancer and cancer therapies are associated with an increased risk of diabetes mellitus. Additionally, genetic factors, obesity, inflammation, oxidative stress, hyperglycemia, hyperinsulinemia, cancer therapies, insulin, and some oral hypoglycemic drugs appear to play a role in the crosstalk between diabetes mellitus and cancers. Thus, we suggest that cancer screening should be conducted in patients with diabetes, and precautions for diabetes should be taken in patients suffering from cancer. Further researches are merited to explore the associations between these different diseases.
Comments are closed.