The effect of diabetes medications on the risk of developing cancer

Published

2 years ago

July 25, 2023

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By Dr. Liji Thomas, MD Jul 25 2023 Reviewed by Danielle Ellis, B.Sc.

Type 2 diabetes melllitus (T2DM) is a common disease, the prevalence of which is increasing exponentially. It is estimated that by 2030, almost 440 million adults below the age of 80 will have diabetes. The consequences of T2DM on health and mortality have long been a focus of study. However, the medications used to control this dreaded disease have their effects on the body, causing specific adverse effects. Study: Diabetes medications and cancer risk associations: a systematic review and meta-analysis of evidence over the past 10 years. Image Credit: fizkes/Shutterstock.com

Cancer is found to occur at higher rates in people with diabetes, probably because both are associated with common risk factors. Diabetes drugs may also contribute to the risk of cancer.

In an attempt to discern the risk of cancer posed by certain diabetic drugs as well, the authors of a recent paper performed a systematic review and meta-analysis of all studies over the past ten years dealing with this topic. The research was published in Scientific Reports. Introduction

Cancer risk factors among people with diabetes include smoking, lack of physical exercise, overweight, and poor dietary quality. These reflect a state of inflammation, high blood sugar levels, and excessive amounts of insulin in the blood. Several studies have also shown that certain cancers occur more often among those who use specific diabetes drug categories.

The current review aimed to bring together the risk of multiple cancer types at various sites with the different types of medication used to treat diabetes. Earlier studies have looked mostly at how one class of medication affects cancer risk at different sites or, conversely, how all diabetes drugs affect cancer risk overall. The main focus remained on cancers of the breast, lung, liver, and pancreas, as well as CRCs.

The various drug classes explored were biguanides, those based on incretins, alpha-glucosidase inhibitors (AGIs), insulin secretagogues, thiazolidinediones, and insulins. What did the study show?

The review included 92 studies, of which three were randomized controlled trials (RCTs), while the majority (64) were cohort studies. The remaining comprised case-control studies. All three RCTs suffered from poor design, leading to a high risk of bias. Related StoriesUSC study reveals key details about how cancer cells metastasizeUnderstanding the impact of HPV on the vaginal microbiome and its role in cervical cancerWhat is the relative burden of oncologic and nononcologic mortality among long-term survivors of cancer in the US?

The cohort studies were mostly at low risk of bias, as were the case-control studies. The most studied cancers were CRCs and pancreatic cancers. Breast and lung cancers were mostly studied in cohort studies. Lung and liver cancers, and CRCs, were studied in both Asian and Western regions, whereas most research on breast, prostate, and pancreatic cancer was carried out in Western populations.

The results showed that colorectal cancer (CRC) and liver cancer occurred at lower rates among diabetic patients who used biguanides to control their blood sugar levels. The risk of liver cancer was reduced by an impressive 45% and that of CRC by 15%. In case-control studies alone, biguanide use was linked to an increase in pancreatic cancer odds by 25%.

Biguanides regulate energy and cellular metabolism, reducing the levels of oxidative stress, inflammation, and apoptosis, along with reduced body fat formation.

Similarly, breast cancer and liver cancer risk were reduced by about 15% with thiazolidinedione use, while the odds of lung cancer were lowered by 44%. These medications reduce the rates of breast cancer cell division and promote apoptosis while restricting neovascularization of tumors. In the liver, these agents cause the protein p27Kip1 to accumulate, limiting liver cell growth and, thus, perhaps, preventing cancerous changes.

Insulin use was linked to a 25% reduction in the odds of prostate cancer and a 10% drop in breast cancer odds. However, insulins were associated with massive increases in the risk of two cancers; pancreatic cancer risk went up by 240%, while there was a 74% increase in the risk of liver cancer.

The raised liver cancer risk was only among Western populations using insulin, with an increase of 250% in this subgroup. Insulin-resistant patients have high insulin levels in the portal circulation, which reaches the liver, and this might account for some of the risks.

Pancreatic cancers might form or grow faster when exposed to insulin, which promotes growth and cell division. However, severe diabetes is itself a risk factor of pancreatic cancer, adding a confounding factor to the etiology.

With insulin secretagogues, the risk of pancreatic cancer went up by 26%. Cohort studies, but not case-control series, showed a 20% rise in associated CRC following insulin secretagogue use. These agents promote insulin secretion by the pancreas, thus raising insulin-like growth factor 1 levels. Enhancing the rate of cell division may promote pancreatic cancer. What are the implications?

Overall, biguanide and thiazolidinedione use carried no risk, or potentially lower risk of some cancers, while insulin secretagogue and insulin use were associated with increased pancreatic cancer risk.”

The benefits of several medications used to treat diabetes extend to a reduction in the associated risk of cancer. At the same time, the risk of pancreatic and liver cancer shot up in association with the use of insulin and of pancreatic cancer with insulin secretagogues, though to a much lesser extent.

While showing associations between medication classes and cancer risk, the study also emphasizes regional differences as well as discrepancies between different study designs. Other confounding factors may have been at work, such as differences in nutritional status.

These findings suggest that it may be important to weigh the potential harms of insulin among patients with diabetes who are at high risk of liver or pancreatic cancers due to family history or other risk factors.” Journal reference: Chen, Y. et al. (2023) "Diabetes medications and cancer risk associations: a systematic review and meta-analysis of evidence over the past 10 years", Scientific Reports, 13(1). doi: 10.1038/s41598-023-38431-z. https://www.nature.com/articles/s41598-023-38431-z

Politics

Victims’ families criticise ‘deeply sensitive decision’ to demolish Grenfell Tower

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2 hours ago

February 6, 2025

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Grenfell Tower to be demolished, as campaigners react to 'divisive and painful debate' over decaying block

Grenfell campaigners have reacted to the “deeply sensitive decision” by the deputy prime minister to demolish the tower block.

Victims’ families and survivors were given the news in a meeting attended by Angela Rayner on Wednesday night.

Grenfell Next of Kin, which represents some of the bereaved families, described it as a “deeply sensitive decision… after a thorough engagement process in person” following an “uncomfortable conversation with uncomfortable truths”.

In a statement on X the group said: “The lack of closure, the continuous discussions and consultations, the retraumatisation of a divisive and painful debate brings nothing to the table except pain and further division.

“We want a discussion about what will go in the Tower’s place so it can be seen and remembered forever. We need to re-imagine a future and rebuild our broken shattered lives and our families.”

The government has previously said there will be no changes to the site before the eighth anniversary of the fire disaster, which claimed 72 lives on 14 June 2017.

It is expected more details will be set out by ministers by the end of the week.

Engineering experts have said that while the tower remains stable, and it is safe for people to live, work and study nearby, its condition will worsen over time and there is no realistic prospect of bringing it back into use.

The latest advice issued to the government in September was that the building, or the part of it that was significantly damaged, should be taken down.

Meanwhile, another campaign group, Grenfell United, claimed Ms Rayner had not given a reason behind her decision during the meeting and refused to say how many of the victims’ families and survivors had been consulted.

In a statement, it said: “But judging from the room alone – the vast majority of whom were bereaved – no one supported her decision. But she claims her decision is based on our views.

“Ignoring the voices of bereaved on the future of our loved ones’ gravesite is disgraceful and unforgivable.”

Grenfell Next of Kin expressed a different opinion, suggesting the decision by Ms Rayner “must have been difficult” and adding that “all the previous Secretaries of State [for Housing, Communities and Local Government] avoided making a decision despite the harm it did to us and the community.”

Local Labour MP Joe Powell also defended Ms Rayner posting on X that following “intensive engagement with our community… the decision to start planning for the Tower to come down has not been taken lightly”.

What is left of the tower has stood in place since the tragedy, with a covering on the building featuring a large green heart accompanied by the words “forever in our hearts”.

Views have varied on what should happen to the site.

Some of the bereaved and survivors feel the tower should remain in place until there are criminal prosecutions over the failings which led to the disaster.

The final report of the Grenfell Tower Inquiry, published in September, concluded the fire was the result of “decades of failure” by government and the construction industry to act on the dangers of flammable materials on high-rise buildings.

The west London tower block was covered in combustible products because of the “systematic dishonesty” of firms who made and sold the cladding and insulation, inquiry chairman Sir Martin Moore-Bick said.

He said the “simple truth” is that all the deaths were avoidable and that those who lived in the tower were “badly failed” by authorities “in most cases through incompetence but, in some cases, through dishonesty and greed”.

However, the Metropolitan Police said last year that decisions on criminal charges for the Grenfell Tower blaze are not expected until the end of 2026.

It would mean a near 10-year wait for justice if anyone is ultimately charged – a period of time described by families as “unbearable”.

The disaster was Britain’s deadliest residential fire since the Second World War and began a national reckoning over the safety and conditions of social housing and tower blocks.

Separately, the Grenfell Tower Memorial Commission has been consulting on plans for a permanent memorial in the area of the tower.

A shortlist of five potential design teams was announced last month, with a winner expected to be selected this summer to enable a planning application to be submitted in late 2026.

A government spokesperson said: “The priority for the deputy prime minister is to meet with and write to the bereaved, survivors and the immediate community to let them know her decision on the future of the Grenfell Tower.

“This is a deeply personal matter for all those affected, and the deputy prime minister is committed to keeping their voice at the heart of this.”

Politics

Conservatives pledge to tighten immigration rules in Reform fightback

Published

2 hours ago

February 6, 2025

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Conservatives pledge to tighten immigration rules in Reform fight back

The Conservative Party is pledging to tighten immigration rules after Reform topped a landmark poll for the first time earlier this week.

In her first major policy announcement as Tory Party leader, Kemi Badenoch is pledging to double the amount of time an immigrant needs to have been in the UK before claiming indefinite leave to remain from five to 10 years.

In order to claim indefinite leave to remain after 10 years, the individual must also meet new, tightened conditions.

These include not having claimed benefits or used social housing during the entire qualification period, not having a criminal record and being able to demonstrate that their household would be a “net contributor”.

Ms Badenoch accused Labour of being “not serious about tackling immigration” and said there needs to be a “new approach”.

“Our country is not a dormitory, it’s our home,” she said.

“The right to citizenship and permanent residency should only go to those who have demonstrated a real commitment to the UK. That’s why we should double the length of time before people can qualify for indefinite leave to remain from five to 10 years.

“The Conservative Party is under new leadership. We’re going to tell the hard truths about immigration.

“The pace of immigration has been too quick and the numbers coming too high for meaningful integration. We need to slow down the track for citizenship. A UK passport should be a privilege not an automatic right.

“Far from reducing the number of people coming into Britain, the Labour government are presiding over an incoming disaster.

“The Border Security Bill will actually make it easier for illegal immigrants to stay in the UK, let alone legal migrants. No one can trust Labour on immigration.”

The announcement comes just days after Reform topped a Sky News/YouGov poll for the first time as the party continues to shake up British politics.

The poll, taken on 2 February and 3 February, showed Nigel Farage’s party has edged in front on 25%, with Labour pushed into second on 24% and the Tories on 21%.

It also put the Lib Dems on 14% and Greens on 9%.

All the polling moves that push Reform UK to the top for the first time this week are within the margin of error and the overall picture remains unchanged – with Britain in a new period of three party politics in the polls.

According to the poll, one in five Tory voters at the last election would now vote for Reform.

The Sky News/YouGov poll also found Kemi Badenoch has slipped behind Nigel Farage when voters are asked whether they have a favourable or unfavourable opinion of the leaders.

Last month, Badenoch had a net favourability rating of -25, but that has now dropped to -29 this month.

This puts her below Farage, who had a net favourability rating of -32 last month, which has now risen to -27 this month.

Labour’s border security minister Dame Angela Eagle said: “While [the Conservatives] scramble around for relevance, this Labour government is getting on with clearing up the mess they left behind – raising deportations, returns and removals to the highest rate in six years, increasing the number of illegal working raids and cutting the costs of the asylum system.”