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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

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Bob Vylan dropped by talent agency – as BBC expresses ‘regret’ over streaming of Glastonbury performance

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Bob Vylan dropped by talent agency - as BBC expresses 'regret' over streaming of Glastonbury performance

The BBC has said it regrets not pulling the live stream of Bob Vylan’s “unacceptable” Glastonbury set – as Ofcom said the broadcaster had “questions to answer”.

The corporation has faced mounting criticism over airing the performance on Glastonbury‘s West Holts Stage, during which the rap-punk duo’s frontman Bobby Vylan led chants of, “free, free Palestine”, and “death, death to the IDF [Israel Defence Forces]”.

Sir Keir Starmer condemned the remarks as “appalling hate speech”, while festival organiser Emily Eavis said they “crossed a line” – and media watchdog Ofcom has now also released a statement raising concerns.

On Monday morning, a spokesperson for the prime minister did not directly answer when asked if he still had confidence in BBC director-general Tim Davie.

Sky News understands the band have since been dropped by representatives United Talent Agency.

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What is the Glastonbury controversy?

During Bob Vylan’s set on Saturday, they performed in front of a screen that showed several messages, including one that said Israel’s actions in Gaza amount to “genocide”.

Footage from the performance shows some of the crowd joining in with the chants.

Amid criticism afterwards, the BBC said there had been a warning on screen about potential “strong and discriminatory language”, but described the comments as “deeply offensive”.

On Monday, a spokesperson released an updated statement, saying the comments were antisemitic and the performance should have been taken off air.

“The BBC respects freedom of expression but stands firmly against incitement to violence,” the statement said. “The antisemitic sentiments expressed by Bob Vylan were utterly unacceptable and have no place on our airwaves. We welcome Glastonbury’s condemnation of the performance.”

Bob Vylan member on stage. Pic: PA
Image:
Pic: PA

A judgement to issue a warning on screen while streaming online was in line with editorial guidelines, the spokesperson added, and the performance has not been made available to view on demand.

“The team were dealing with a live situation but with hindsight we should have pulled the stream during the performance. We regret this did not happen.

“In light of this weekend, we will look at our guidance around live events so we can be sure teams are clear on when it is acceptable to keep output on air.”

Ofcom’s reaction

An Ofcom spokesperson said: “We are very concerned about the live stream of this performance, and the BBC clearly has questions to answer.

“We have been speaking to the BBC over the weekend and we are obtaining further information as a matter of urgency, including what procedures were in place to ensure compliance with its own editorial guidelines.”

In a statement shared on Instagram on Sunday, Bobby Vylan said: “Teaching our children to speak up for the change they want and need is the only way that we make this world a better place.

“As we grow older and our fire starts to possibly dim under the suffocation of adult life and all its responsibilities, it is incredibly important that we encourage and inspire future generations to pick up the torch that was passed to us.”

The latest developments follows severe condemnation from the prime minister, who said there was “no excuse for this kind of appalling hate speech”.

Mo Chara of Kneecap at Glastonbury. Pic: Reuters
Image:
Mo Chara of Kneecap at Glastonbury. Pic: Reuters

Sir Keir also referenced a previous statement that Belfast rap group Kneecap, who were on stage after Bob Vylan, should have been removed from the line-up after one member was charged with a terrorism offence.

“I said that Kneecap should not be given a platform and that goes for any other performers making threats or inciting violence,” he said.

Ms Eavis, whose father Michael co-founded the festival, said in a statement that Bob Vylan had “very much crossed a line”.

She added: “Their chants very much crossed a line and we are urgently reminding everyone involved in the production of the festival that there is no place at Glastonbury for antisemitism, hate speech or incitement to violence.”

Read more:
Who are Bob Vylan?
British-Israeli soldier killed while fighting in Gaza
Trump calls for ceasefire deal

The Israeli embassy posted on X in the hours after the set, saying it was “deeply disturbed by the inflammatory and hateful rhetoric”.

It said the slogan used “advocates for the dismantling of the State of Israel”.

In a separate post on X on Sunday, Israel’s foreign ministry published graphic footage following the attack by Hamas on the Nova festival in Israel on 7 October 2023, and the Campaign Against Antisemitism (CAA) said it would be formally complaining to the BBC over its “outrageous decision” to broadcast the performance.

Speaking to Sky News’ Sunday Morning With Trevor Phillips on behalf of the government, Health Secretary Wes Streeting described the chant as “appalling”, especially at a music festival – “when there were Israelis at a similar music festival who were kidnapped, murdered, raped, and in some cases still held captive”.

He added that while “there’s no justification for inciting violence against Israelis… the way in which Israel’s conducting this war has made it extremely difficult for Israel’s allies around the world to stand by and justify”.

Lucy McMullin, who was in the crowd for Bob Vylan, told Sky News: “When there’s children and civilians being murdered and starved, then I think it’s important that people are speaking out on these issues.

“However, inciting more death and violence is not the way to do it.”

Police have said they are reviewing footage of both the Bob Vylan and Kneecap sets to assess whether any criminal offences were committed.

Speaking to Sky News, women and equalities minister Baroness Jacqui Smith said the comments “clearly” over-stepped the mark.

“I’m surprised that the BBC carried on broadcasting them live when it was obvious what was happening.”

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RuPaul’s Drag Race star The Vivienne died by ‘misadventure’, inquest finds

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RuPaul's Drag Race star The Vivienne died by 'misadventure', inquest finds

An inquest has found drag queen The Vivienne did not intend to take their life when they died after taking ketamine.

Coroner Jacqueline Devonish concluded The Vivienne, whose real name is James Lee Williams, died by “misadventure” after suffering cardio respiratory arrest.

Williams, who won the first series of RuPaul’s Drag Race UK in 2019, was found dead at the age of 32 in the bath at their home in Cheshire on 5 January this year.

In March, the star’s family revealed the performer had died “from the effects of ketamine use causing a cardiac arrest”, saying they wanted to raise awareness about the dangers of the drug.

Cheshire Coroner’s Court heard five drug snap bags were found, including in a bedroom draw and a bin in the bathroom, in their home in Chorlton-by-Backford, near Chester.

Police attended and confirmed there were no suspicious circumstances.

The inquest heard friends and family had no worries about Williams’s mental health and the performer was looking forward to future roles on TV and in the theatre, although did “occasionally” take ketamine.

The star’s family told the hearing the performer should not be remembered for their use of the Class B drug and that drugs did not define the person they were.

Williams’s father Lee Williams described them as “an outgoing character who was full of life” and “just wanted to make people laugh”.

“He achieved his goals. He had future goals he wanted to achieve. Along the way he always wanted to try to help his community, which he did and try to help other drag queens,” he said.

“He was always available. He never turned anybody down. He never turned his back on anybody. He never said no.

“He loved the stage, that’s where he saw the rest of his career being, on the stage, in the theatre. That’s what he loved to do.”

Williams’s funeral in Bodelwyddan, Denbighshire, North Wales, was attended by RuPaul’s Drag Race UK contestants Tia Kofi and Baga Chipz, along with Steps singer Ian “H” Watkins, TV personality Kim Woodburn and Coronation Street actress Claire Sweeney.

The Vivienne poses for photographers upon arrival at the premiere of the film 'Wicked' on Monday, Nov. 18, 2024, in London. (Photo by Millie Turner/Invision/AP)
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The Vivienne at the premiere of the film ‘Wicked’ in November 2024. Pic: AP

During their time on the show, under their drag name, Williams admitted having been a drug addict for four years.

“It was party, drugs, but I couldn’t leave the drugs at the party, it was constant for me,” they said.

They added that their addiction was a “habit that caught on a bit too quick and a bit too hard”.

The TV personality, who grew up in Colwyn Bay, North Wales, before moving to Liverpool, came third in the 2023 edition of Dancing On Ice.

The star performed as the Wicked Witch of the West in a UK and Ireland tour of The Wizard Of Oz musical and reprised the role in the West End at the Gillian Lynne Theatre last year.

They were due back on stage in March as the Childcatcher in a tour of Chitty Chitty Bang Bang, a role they first played last year.

The government is seeking expert advice after illegal use of ketamine surged to record levels.

In the year ending March 2023, an estimated 299,000 people aged 16 to 59 had reported use of the substance, which is controlled as class B, according to the Home Office.

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Oracle stock jumps after $30 billion annual cloud deal revealed in filing

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Oracle stock jumps after  billion annual cloud deal revealed in filing

Oracle CEO Safra Catz speaks at the FII PRIORITY Summit in Miami Beach, Florida, on Feb. 20, 2025.

Joe Raedle | Getty Images

Oracle shares jumped more than 5% after a recent filing showed a cloud deal that would add over $30 billion annually.

CEO Safra Catz is slated to share the deal news at a company meeting Monday, according to a filing with the Securities and Exchange Commission. The revenues are expected to start hitting in the 2028 fiscal year.

“Oracle is off to a strong start in FY26,” Catz is expected to say, according to the filing. “Our MultiCloud database revenue continues to grow at over 100%, and we signed multiple large cloud services agreements including one that is expected to contribute more than $30 billion in annual revenue starting in FY28.”

The deals revealed Monday by Catz will not affect the company’s 2026 guidance, according to the filing.

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Oracle shares hit record high

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