Blog entry by Meguid El Nahas

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by Meguid El Nahas - Monday, 28 January 2013, 10:40 PM
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Prevalence of Diagnosed Cancer According to Duration of Diagnosed Diabetes and Current Insulin Use Among U.S. Adults With Diagnosed Diabetes Findings from the 2009 Behavioral Risk Factor Surveillance System


Diabetes Care Publish Ahead of Print, published online January 8, 2013

this article recently published in diabetes care raises suspicious about long term insulin use in T2DM and cancer .
The aim of the study was to To determine whether longer duration of diagnosed diabetes and current insulin use are associated with increased prevalence of cancer among adults with diagnosed diabetes,
Authors analyzed a large population-based sample from the 2009 Behavioral Risk Factor Surveillance
System (BRFSS) in the U.S. The BRFSS is a standardized telephone survey that assesses key
behavioral risk factors, lifestyle habits,and chronic illnesses and conditions among adults aged $18 years in all U.S.
RESULT :There were a total of 34,424 adults with diagnosed diabetes participating in the survey with the diabetes module. Of them, 8,460 had missing data on diabetes age, insulin use, and selected covariates. Among adults with diagnosed diabetes and with complete data on cancer and diabetes-related covariates (n = 25,964), there were 11,165 men (weighted percentage, 52.8%), 18,673
NH whites (65.3%), 3,575 NH blacks (16.0%), 2,348 Hispanics (13.1%), and 1,368 participants with NH other race/ ethnicity (5.6%). Approximately 4.7% of adults with diagnosed diabetes were estimated
to have type 1 diabetes (n = 491 men and 721 women), 70.5% were type 2 diabeticwithout current insulin use (n = 7,820 men and 10,475 women), and 24.8% were type 2 diabetic with current insulin use (n = 2,854 men and 3,603 women). The mean age was 58.6 years (median 59.0 years). The mean age at diabetes
diagnosis was 47.6 years (49.0 years).
The unadjusted prevalence for cancers of all sites among men with type 2 diabetes and current insulin use was higher than those with either type 1 diabetes (P , 0.001) or those with type 2 diabetes and
no current insulin use (P , 0.001) among both men and women.
After adjustment for age, the difference in the prevalence estimates for cancers of all sites
remained between adults with type 2 diabetes with current insulin use and those with type 2 diabetes with no current insulin use among men (P , 0.001) and women (P , 0.001).
Among both men and women with
type 2 diabetes, the prevalence estimates for cancers of all sites were significantly higher among those who had diabetes >15 years than among those who had diabetes ,15 years after adjustment for all
selected covariates . Specifically,the prevalence was estimated to be significantly higher among adults
who had diabetes $15 years for colon cancer, melanoma, nonmelanoma skin cancer, and cancer of urinary tract among men and the cancers of the breast, female reproductive tract, and skin among women than those who had diabetes ,15 years. Among both men and women with type 2 diabetes, the prevalence estimate for cancers of all sites was ~1.5 times higher among those who used insulin than those who did not use insulin after adjustment for demographic characteristics and selected health risk factors.
current insulin
use remained significantly associated with increased prevalence of cancers of all sites among both men and women and increased prevalence of skin cancer (both melanoma and nonmelanoma) among men and cancer of the reproductive tract .
My comments:
1-The relation between Insulin use and cancer needs more attention and further .Further research may be warranted.
2-The major strength this study was the use of a large population-based sample,
which enabled investigators to provide stable estimates of cancer prevalence among adults with diabetes in the general population.
3- There were also several limitations , the study is a cross-sectional study in which persons who self-reported diagnosed cancer were cancer survivors and included those who were newly diagnosed and those who had a preexisting condition. Persons who died of cancer were excluded in this self-reported cross-sectional survey. Therefore, these results based on the prevalence of diagnosed cancer suggest crosss ectional associations and preclude causal associations between duration of diagnosed
diabetes or current insulin use and cancer.
4-Age at diagnosis of diabetes or cancer, current insulin use, and cancer types were self-reported by survey participants; thus, recall bias may be possible.
5-duration of diagnosed diabetes may not represent actual duration of exposure to diabetes because people may be asymptomatic for many years before medical diagnosis.
However and again this study raised the red flag between possible association between insulin and cancer that was raised before for Lantus.
Professor Alaa Sabry
[ Modified: Thursday, 1 January 1970, 1:00 AM ]