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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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Liam Payne’s girlfriend Kate Cassidy says death ‘still doesn’t feel real’ – and reveals why she left him in Argentina

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Liam Payne's girlfriend Kate Cassidy says death 'still doesn't feel real' - and reveals why she left him in Argentina

Liam Payne’s girlfriend has said his death was a “tragic accident” and he was in “such a good headspace” when she left him in Argentina.

Kate Cassidy was with Payne in Buenos Aires but flew back to the US days before the One Direction star was killed in a fall from a hotel balcony.

She told The Sun: “Love is so optimistic, and you just hope that everything will work out at the end.

“Obviously if I knew, if I could see into the future, I would never have left Argentina.”

The American influencer said she had to get back to look after the couple’s dog, Nala.

“I had a responsibility, we had a responsibility. We had our dog and obviously I never, ever thought this event would occur,” she said.

Cassidy added: “It was a tragic accident and no, I never did think [he might die young]. But, you know, we did have our own separate lives – this wasn’t the first time we have travelled separately.

“I just never thought this would have happened, that it would turn out the way it did.”

Payne died aged 31 on 16 October from multiple injuries after falling from the third floor of a hotel in the Argentine capital.

Three people have been charged with manslaughter over his death, and two with supplying cocaine.

The Casa Sur Hotel in Buenos Aires where Liam Payne died on Wednesday night. (Pic: Reuters)
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Payne fell from the third floor at the Casa Sur Hotel in Buenos Aires. Pic: Reuters

Cassidy, 25, said she thinks about Payne “every second of every day” and that she’d had a “childhood crush” on him since she was 10.

The pair got together in 2022 and she told The Sun it still doesn’t seem “fully real for me that he’s not here”.

“From the moment I met Liam, I genuinely believed we were soulmates,” said Cassidy.

“He was the most humble, charming, normal person you could ever hope to come across, and genuinely one of the best people I’ve ever met in my life.”

She said the Wolverhampton-born singer “was in such a good headspace” when she left Argentina.

“We were in such a great place, just full of love; he was so happy and positive. And I just can’t even believe the way things truly ended,” she said.

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Five people have been charged in connection with Payne’s death

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Cassidy said she was glad she didn’t discover he’d died via social media, revealing one of Payne’s friends had called her to break the news.

“That moment, it’s like blank; it’s blacked out in my head,” she added.

“I didn’t believe it at first. I thought it was just a rumour. Or something that somebody made up just to get views.”

Payne’s funeral took place in November in Buckinghamshire, with his former bandmates and ex-partner Cheryl among the mourners.

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‘Dangerous climate breakdown’ warning as hottest January on record shocks scientists

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'Dangerous climate breakdown' warning as hottest January on record shocks scientists

Last month was the warmest January on record, according to new data.

The finding has baffled scientists, who had expected changes in ocean currents in the Pacific to take the edge off rising global temperatures.

Figures released by the European Copernicus climate service show average temperatures around the world in January were 1.75C warmer than before greenhouse gas emissions started to rise significantly in the industrial revolution around 150 years ago.

That’s 0.1C above the record set last January. And it comes after a year in which temperatures topped 1.5C, the target for climate negotiations, for the first time.

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2024 was the warmest year on record

Dr Friederike Otto, a climate scientist at Imperial College London, warned that the rising pace of climate change would increase the risk of extreme weather and its consequences.

“This January is the hottest on record because countries are still burning huge amounts of oil, gas and coal,” she said.

“The Los Angeles wildfires were a stark reminder that we have already reached an incredibly dangerous level of warming. We’ll see many more unprecedented extreme weather events in 2025.”

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January had been expected to be slightly cooler than last year because of a natural shift in weather patterns and ocean currents in the Pacific, called La Nina.

But that hasn’t been enough to slow the upward trend in temperatures.

‘Frankly terrifying’

Bill McGuire, emeritus professor of geophysical & climate hazards at UCL, said: “The fact that the latest robust Copernicus data reveals the January just gone was the hottest on record – despite an emerging La Nina, which typically has a cooling effect – is both astonishing and, frankly terrifying.

“Having crashed through the 1.5C limit in 2024, the climate is showing no signs of wanting to dip under it again, reflected by the fact that this is the 18th of the last 19 months to see the global temperature rise since pre-industrial times top 1.5C.

“On the basis of the Valencia floods and apocalyptic LA wildfires, I don’t think there can be any doubt that dangerous, all-pervasive, climate breakdown has arrived.”

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The consequences of a warming atmosphere are also being directly felt in the UK, with more intense rainfall increasing the risk of surface flooding.

The Environment Agency released figures in December showing 4.6 million properties in England are at risk from flooding as drainage systems are overwhelmed by rainfall. That’s a 43% increase on previous estimates.

But adapting to a climate change is hugely expensive.

The government on Wednesday announced it would spend £2.65bn over two years to shore up existing flood defences and protect an extra 52,000 homes and businesses – a tiny fraction of the number at risk.

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Ancient scrolls near Pompeii were preserved but unreadable – are they now revealing their secrets?

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Ancient scrolls near Pompeii were preserved but unreadable - are they now revealing their secrets?

Ancient scrolls charred by a volcanic eruption 2,000 years ago may finally be starting to reveal their secrets.

UK scientists say they have made a historic breakthrough in their efforts to decipher the artefacts – with the assistance of AI.

Hundreds of papyrus scrolls were found in the 1750s in the remains of a lavish villa at the Roman town of Herculaneum, which along with nearby Pompeii was destroyed when Mount Vesuvius erupted in 79AD.

While the heat and ash from the volcano was catastrophic for the town, it preserved the scrolls – though in an unreadable state.

This undated image made available by Vesuvius Challenge shows an X-ray scan of part of papyrus scroll PHerc.172, showing the word 'disgust', one of hundreds of papyrus scrolls found amid the remains of a lavish villa at the Roman town of Herculaneum, which along with neighboring Pompeii was destroyed when Mt. Vesuvius erupted in A.D. 79. (Vesuvius Challenge via AP)
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An X-ray scan of part of one of the scrolls. Pic: AP

Scholars and scientists have been working for more than 250 years on ways to decipher the scrolls, which are too fragile to be unrolled physically.

In 2023, several tech executives sponsored the “Vesuvius Challenge” competition, offering cash prizes for efforts to decipher the scrolls with technology.

On Wednesday, the challenge announced a “historic breakthrough,” saying researchers had managed to generate the first image of the inside of one of the three scrolls held at Oxford University’s Bodleian Library.

University of Kentucky computer scientist Brent Seales, co-founder of the challenge, said the organisers were “thrilled with the successful imaging of this scroll”, saying it “contains more recoverable text than we have ever seen in a scanned Herculaneum scroll”.

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The scroll was scanned by Diamond Light Source, a lab in Harwell, near Oxford, by using a particle accelerator known as a synchrotron to create an intensely powerful X-ray.

AI was then used to piece together the images, searching for ink that reveals where writing is located. A 3D image of the scroll can then be formulated that allows experts to unroll it virtually.

Little of the text has been deciphered so far. One of the few words that has been made out is the ancient Greek for “disgust”.

Peter Toth, a curator at the Bodleian Library, said: “We need better images, and they are very positive and very, very confident that they can still improve the image quality and the legibility of the text.

“And then don’t forget that there is like 1,000 more scrolls in Naples.”

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