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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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Criminal investigation launched into Glastonbury performances of Kneecap and Bob Vylan

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Criminal investigation launched into Glastonbury performances of Kneecap and Bob Vylan

A criminal investigation has been launched into the Glastonbury performances of Kneecap and Bob Vylan.

Police announced the decision on Monday afternoon after reviewing video footage and audio of both sets, which took place on Saturday.

It comes after the BBC said it regretted the decision not to pull the live stream for Bob Vylan’s Glastonbury performance, during which frontman Bobby Vylan shouted anti-IDF (Israel Defence Forces) chants.

The punk-rap duo have also had US visas revoked and been dropped by their US representative, United Talent Agency.

Later on Monday, as the story had made headlines throughout the day, drummer Bobbie Vylan released a video statement on Instagram, saying politicians who have spent time criticising the band should be “utterly ashamed” for giving “room” to this over other issues.

He also addressed what was said on stage, saying: “Regardless of how it was said, calling for an end to the slaughter of innocents is never wrong. To civilians of Israel, understand this anger is not directed at you, and don’t let your government persuade you that a call against an army is a call against the people.”

Moglai Bap and Mo Chara of Kneecap perform at Glastonbury. Pic: Reuters
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Moglai Bap and Mo Chara of Kneecap perform at Glastonbury. Pic: Reuters

In a statement, Avon and Somerset Police said that after reviewing footage of both performances, further enquiries are required and a criminal investigation is now being undertaken.

“A senior detective has been appointed to lead this investigation,” a spokesperson said. “This has been recorded as a public order incident at this time while our enquiries are at an early stage.”

The force said the investigation will be “evidence-led and will closely consider all appropriate legislation, including relating to hate crimes”.

“We have received a large amount of contact in relation to these events from people across the world and recognise the strength of public feeling,” it added. “There is absolutely no place in society for hate.”

What happened?

Bob Vylan performing on the West Holts Stage, during the Glastonbury Festival at Worthy Farm in Somerset. Yui Mok/PA Wire
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Bob Vylan performing on the West Holts Stage, during the Glastonbury Festival at Worthy Farm in Somerset. Yui Mok/PA Wire

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

Bobby Vylan also led chants of “death to the IDF”.

The set was live streamed by the BBC as part of its Glastonbury coverage, but has not been made available on demand.

Politicians including the prime minister have criticised the performance. Glastonbury organiser Emily Eavis said the chants “crossed a line” and that there was no place at the festival for “antisemitism, hate speech or incitement to violence”.

A BBC spokesperson said the broadcaster respected freedom of expression “but stands firmly against incitement to violence”.

They added: “The antisemitic sentiments expressed by Bob Vylan were utterly unacceptable and have no place on our airwaves…

“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.”

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What’s the Glastonbury controversy?

Media watchdog Ofcom said it was in talks with the BBC and that the broadcaster “clearly has questions to answer” over the stream.

Irish-language rap trio Kneecap were on stage afterwards. Before their appearance at the festival, there had been calls for Glastonbury to remove them from the bill – as rapper Liam Og O hAnnaidh (who performs as Mo Chara) is facing a terror charge, accused of displaying a flag in support of the proscribed group Hezbollah at a gig in London last November.

Glastonbury organisers kept them on the line-up, but the BBC chose not to stream their set live. An edited version was later made available on demand.

On stage, the band led chants of “f*** Keir Starmer”.

O hAnnaidh’s bandmate Naoise O Caireallain (Moglai Bap) said they would “start a riot outside the courts” for O hAnnaidh’s next appearance, before clarifying: “No riots, just love and support, and support for Palestine.”

Hundreds of people turned out in protest for his first court appearance earlier this month.

After the police investigation was announced, Culture Secretary Lisa Nandy criticised the “appalling and unacceptable” scenes at Glastonbury and said the government would not tolerate antisemitism.

She said she had called BBC director-general Tim Davie after the broadcast of Bob Vylan’s set to find out why it had aired, and why the feed had not been cut.

“I expect answers to these questions without delay,” she said.

Ms Nandy said she had spoken to members of the Jewish community, including attendees at Glastonbury, who said they were concerned by imagery and slogans and ended up creating their own “safe space”.

Christopher Landau, the US deputy secretary of state, said the band had been banned from the US ahead of a tour later this year due to their “hateful tirade” at the festival.

Bob Vylan were set to perform in Chicago, Brooklyn and Philadelphia in the autumn. They are due to perform at Radar Festival in Manchester on Saturday and Boardmasters, a surfing and music festival in Newquay, Cornwall, in August.

Sharing a statement on Instagram after the Glastonbury set, 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 war in Gaza, which has continued for more than 18 months, began after Hamas militants launched attacks in Israel on 7 October 2023, killing 1,200 people and taking roughly 250 hostages.

More than 860 Israeli soldiers have been killed since the war began, more than 400 of them during the fighting in Gaza.

Israel’s offensive in Gaza has devastated the enclave and killed around 56,500 people, according to the Hamas-run health ministry, which does not differentiate between civilians and combatants, but says more than half of the dead are women and children.

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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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Suit accusing BYU QB Retzlaff of rape dismissed

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Suit accusing BYU QB Retzlaff of rape dismissed

A civil lawsuit accusing BYU quarterback Jake Retzlaff of rape has been dismissed, according to court records.

The parties jointly agreed to dismiss with prejudice, ending the case which was filed last month. None of the parties was immediately available for comment.

Retzlaff now plans to transfer from BYU as he faces a possible seven-game suspension for violating the school’s honor code by admitting to premarital sex during the legal proceedings, sources told ESPN. He has begun informing staff and teammates of his intention to leave, sources said.

Retzlaff had been working out with the squad and participating in summer workouts and practices. The team is on break until July 7.

The BYU staff has been ramping up the preparation of the three backup quarterbacks — McCae Hillstead, Treyson Bourguet and Bear Bachmeier — in anticipation that Retzlaff might not be available.

The woman alleged Retzlaff raped, strangled and bit her in November 2023. In a response to that lawsuit filed Friday, a lawyer representing Retzlaff denied those allegations but said Retzlaff had consensual sex with the woman.

The response indicated Retzlaff and the woman traded lighthearted text messages for months after the encounter and characterized the lawsuit as an extortion attempt based on the idea that Retzlaff developed into an NFL prospect roughly a year later.

The lawsuit described the encounter much differently.

Both the complaint and the response agree that Retzlaff and the woman connected through social media, which led to her visiting Retzlaff’s apartment to play video games on or around Nov. 22, 2023. The woman arrived with a friend, and friends and teammates of Retzlaff also were present.

Later that evening, the woman’s friend left, after which Retzlaff and the woman started watching a movie and began to kiss, the lawsuit states. While “Retzlaff began escalating the situation,” the suit says, “Jane Doe A.G. tried to de-escalate the situation and attempted to slow things down, trying to pull away, and saying ‘wait.’ She did not want to do anything sexual with him.”

The lawsuit says the woman told Retzlaff “no” and “wait, stop,” but he continued to force himself on her. After she tried to get up out of the bed, the lawsuit alleges, in graphic detail, that Retzlaff put his hands around her neck and proceeded to rape her.

A few days later, the woman visited a hospital, where a rape kit was performed and pictures of her injuries were taken. The lawsuit says she was connected with Provo, Utah, police but did not initially share Retzlaff’s name.

No criminal charges have been filed against Retzlaff.

After the lawsuit was filed, BYU issued a statement, saying: “The university takes any allegation very seriously, following all processes and guidelines mandated by Title IX. Due to federal and university privacy laws and practices for students, the university will not be able to provide additional comment.”

Retzlaff is not the first high-profile BYU athlete who faced a lengthy suspension for an honor code violation related to premarital sex. In 2011, basketball player Brandon Davies was dismissed from the team — which at the time was 27-2 and ranked No. 3 in the country — and suspended from school. He was reinstated that fall. In 1999, running back Reno Mahe was suspended from school and forced to leave the football team. He transferred to a junior college and later reenrolled at BYU.

Retzlaff, who has graduated from BYU, is expected to enter his name in the transfer portal in the coming days. He started 13 games for the Cougars in 2024, his first year as the starter, leading the team to an 11-2 record. He passed for 2,947 yards and 20 touchdowns with 12 interceptions.

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