Risk factors for cancer development in type 2 diabetes: A retrospective case-control study

BACKGROUND

The risk of several types of cancer is increased in type 2 diabetes mellitus. The earliest possible diagnosis of cancer - difficult within regular outpatient diabetes care - is of utmost importance for patients' survival. The aim of this multicenter, retrospective (years 1998-2015), case-control study was to identify risk factors associated with malignancy in subjects with diabetes treated in a typical outpatient setting.

METHODS

In the databases of 3 diabetic and 1 primary care clinics 203 patients (115 women) with type 2 diabetes mellitus who developed malignancy while treated for diabetes were identified. The control group consisted of 203 strictly age- and gender matched subjects with type 2 diabetes without cancer. Factors associated with diabetes: disease duration, antidiabetic medications use and metabolic control of diabetes were analyzed. Also other variables: BMI (body mass index), smoking habits, place of residence and comorbidities were included into analysis.

RESULTS

The most prevalent malignancies in men and women together were breast cancer (20.7 %) and colorectal cancer (16.3 %). HbA1c (hemoglobin A1c) level ≥8.5 %, obesity and insulin treatment in dose-dependent and time-varying manner demonstrated significant association with increased risk of malignancy, while metformin use was associated with a lower risk of cancer. Diabetes duration, comorbidities, smoking habits, place of residence and aspirin use did not show significant association with risk of malignancy.

CONCLUSIONS

In the outpatient setting the obese patients with poorly controlled insulin treated type 2 diabetes mellitus should be rigorously assessed towards malignancies, particularly breast cancer in women and colorectal cancer in men.

Diabetes as a risk factor of hospitalization in the surgical ward due to cancer in the elderly and middle-aged population

INTRODUCTION

Diabetes can be considered as a risk factor of several types of malignancy. Surgery is one of the primary methods of cancer treatment. The objective of this study was to evaluate the association between diabetes and hospital admissions to the surgery unit due to malignancy among elderly and middle-aged people.

MATERIAL AND METHODS

Data for analysis were taken from the medical records of 7,694 patients aged > 45, hospitalized in the General Surgery Ward in the Specialist District Hospital in Stalowa Wola in the Subcarpathian (Podkarpacie) Province, Poland, in the years 2010-2013. Among them malignancy was diagnosed in 652 patients and diabetes in 370 subjects. Ninety-three patients suffered from both diabetes and cancer.

RESULTS

Diabetes was associated with significantly elevated risk of hospitalization due to malignancy compared with the non-diabetic population, odds ratio (OR) 4.051 (95% confidence interval: 3.154-5.203), p < 0.001. Among people with diabetes, elderly patients (> 65 years) had higher risk of hospital admission due to cancer compared with the middle-aged population, OR = 5.238 (2.873-9.550), p < 0.001. Also, urban residents had higher risk compared with rural inhabitants, OR = 2.272 (1.375-3.752), p = 0.002.

CONCLUSIONS

Patients with diabetes, especially elderly and urban inhabitants, are at high risk of hospital admission due to malignancy. This indicates the need for oncological vigilance in such patients for early detection and treatment of cancers common in this population.

Association between hearing organ and renal function in young adult type 1 diabetic patients: A cross-sectional study

Type 1 diabetes can lead to impaired function of many organs and tissues. The aim of this study was to evaluate associations between hearing and kidney function in young adult type 1 diabetic patients. 31 patients (9 women) with type 1 diabetes, aged <45, with disease duration <10 years were included. Blood and urine samples for laboratory tests and urinary albumin excretion (UAE) assessment were obtained. eGFR was calculated with CKD-EPI formula. In all patients pure-tone audiometry, transient evoked otoacoustic emissions and auditory brainstem responses were evaluated, also eye fundus was examined. Mean patients' age was 29.5 ± 7.0 years and disease duration 4.6 ± 2.6 years. All patients had eGFR > 60.0 ml/min/1.73 m2. In one case microalbuminuria and in 3 patients early retinopathy were revealed. Linear correlation between eGFR and hearing threshold at 4, 6, 8 and 12 kHz was found. Patients with hearing impairment (n = 7) had lower eGFR 108.8 vs. 121.7 ml/min/1.73 m2, p = 0.047 compared to normal-hearing subjects. Also patients with absence of otoacoustic emissions in at least one ear had lower eGFR, 103.1 vs. 123.3 ml/min/1.73 m2, p < 0.001, compared to the remaining group. In auditory brainstem responses we found significant linear correlation between eGFR and wave III and interval I-III latencies, and between UAE and waves III, V and interval I-III latencies. This study suggests existence of relationship between hearing and kidney function in type 1 diabetic patients. Pathways directly linking hearing and renal function are unknown. Larger studies are necessary to further analyze these relationships.

Differences in risk factors of malignancy between men and women with type 2 diabetes: A retrospective case-control study

BACKGROUND

The aim of this multicenter, retrospective, case-control study was to identify differences in risk factors of malignancy between men and women with type 2 diabetes.

RESULTS

Among women the most prevalent malignancies were: breast and uterine cancers (35.6% and 14.4% respectively), while among men there were: colorectal and prostate cancers (24.5% and 13.3% respectively). In both gender metformin use was associated with lower cancer risk. Obesity and insulin treatment in dose-dependent and time-varying manner were associated with significantly increased risk of malignancy in females. In men, unexpectedly, cardiovascular disease was more prevalent in control group. Other variables did not show significant association with malignancy risk.

MATERIALS AND METHODS

118 women and 98 men with type 2 diabetes mellitus who developed cancer after diagnosis of diabetes and the same number of strictly age matched controls with type 2 diabetes and without malignancy were included into the study. Diabetes duration, antidiabetic medications use, glycated hemoglobin level, body mass index, smoking habits, occupation, presence of comorbidities and aspirin use were included into analyses.

CONCLUSIONS

Metformin demonstrated protective effect against cancer in both sexes. Obesity and insulin treatment seem to have greater impact on cancer risk among women.

Knowledge of Medical Students and Medical Professionals Regarding Nutritional Deficiencies in Patients with Celiac Disease

A gluten-free diet provides relief from symptoms for patients with celiac disease, although there is still a risk of nutritional deficiencies. These patients can potentially consume an excessive amount of fat and insufficient amounts of fiber, iron, vitamin D, and calcium. This study aimed to assess the knowledge of medical students and healthcare professionals in Poland regarding nutritional deficiencies and the prevention of such deficiencies in patients with celiac disease who are on a gluten-free diet. Of the 430 survey participants, 46% did not realize the risk of nutritional deficiencies in patients with celiac disease. The knowledge of the participants was lowest regarding the risk of being overweight or obese. Among the healthcare professionals, an acceptable level of correct answers was provided by only 37% of individuals and was highest for the dietitians' group. Our results demonstrate the need to improve the education of healthcare professionals concerning nutrition in patients with celiac disease.

Beneficial Effect of Dietary Approaches to Stop Hypertension Diet Combined with Regular Physical Activity on Fat Mass and Anthropometric and Metabolic Parameters in People with Overweight and Obesity

BACKGROUND/OBJECTIVE

Obesity and overweight have become growing health-related issues worldwide, which also applies to Poland. Excess fat mass is associated with an increased risk of metabolic and non-metabolic complications. The aim of our pre-post-designed study was to assess the effect of behavioral intervention on body weight, fat mass and anthropometric and metabolic parameters in obese and overweight individuals.

METHODS

The study included one hundred people (85 women) with excess fat mass who voluntarily declared their willingness to participate in the weight-loss program consisted of 12 weeks of the DASH diet combined with regular, supervised physical activity. Anthropometric measurements and laboratory tests were performed in all study participants, and anthropometric and metabolic indices were calculated at baseline and after three months of treatment.

RESULTS

Body weight decreased significantly by 5.63 ± 4.03 kg, BMI by 2.06 ± 1.44 kg/m2, waist circumference by 5.6 ± 3.7 cm, fat mass from 40.04 ± 6.90 to 36.56 ± 7.07% and uric acid level by 16.0 ± 41.6 μmol/L (p < 0.001 in all cases). We also found an improvement in lipid profile and anthropometric and metabolic indices, except for HDL cholesterol and plasma glucose levels.

CONCLUSIONS

The effect of the DASH diet and supervised physical activity was beneficial regardless of age, sex and the presence of hypertension or dysglycemia at baseline. The implementation of a healthy lifestyle was associated with a significant improvement in anthropometric and metabolic parameters, which, if continued, may reduce the risk of unfavorable health-related outcomes in the future.