Prediabetes increases cancer risk

Wednesday, September 17, 2014. A meta-analysis described on September 11, 2014 in the journal Diabetologia adds evidence to an association between prediabetes and a greater risk of cancer. Prediabetes describes a stage between normal blood sugar levels and diabetes, and includes those with impairments in glucose tolerance and/or fasting glucose.

Yi Huang of China's First People's Hospital of Shunde and associates selected 16 prospective studies involving a total of 891,426 participants from different parts of the world for their analysis. They found a 15% higher risk of cancer among prediabetics that was consistent across ages, ethnicities and other factors. The lower definition of impaired fasting glucose used by the American Diabetes Association of 100 mg/dL to 124 mg/dL (5.6 mmol/L to 6.9 mmol/L) was associated with a risk of cancer that was not significantly different than that associated with prediabetes as defined by other organizations that utilize fasting plasma glucose levels of 110 mg/dL to 124 mg/dL (6.1 mmol/L to 6.9 mmol/L).

When cancer was evaluated according to type, the association was significant for stomach/colorectal, liver, pancreatic, breast and endometrial cancers. Liver cancer had the strongest association, with prediabetics experiencing nearly double the increase in risk.

The authors suggest that chronic oxidative stress and increased advanced glycation end products resulting from elevated blood glucose could be behind the increase in cancer risk uncovered in this analysis. Additionally, cancer cell growth can be stimulated by increased insulin secretion that occurs with insulin resistance. Furthermore, there may be genetic variations that increase the risk of cancer as well as prediabetes.

"It should be noted that metformin — one of several first line therapies available to treat type 2 diabetes — is now considered as having some 'protective' anticancer properties," Dr Huang and colleagues write. "Notably, metformin mediates an approximately 30% reduction in the lifetime risk of cancer in diabetic patients. However, whether this is true in prediabetic individuals is not yet known. Long-term, large-scale studies of high-risk individuals, especially those with impaired glucose tolerance or a combination of impaired glucose tolerance and impaired fasting glucose, are urgently needed to explore the effects of metformin interventions on the risk of cancer in people with prediabetes."

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Health Concern

Diabetes

One of the best defenses against mild to moderate type 2 diabetes and hyperinsulinemia is improved diet and exercise. Although the disease has a genetic component, many studies have shown that diet and exercise can prevent it (Diabetes Prevention Program Research Group 2002; Diabetes Prevention Program Research Group 2003; Muniyappa 2003; Diabetes Prevention Program Research Group 2000). One study also showed that while some medications delay the development of diabetes, diet and exercise work better. Just 30 minutes a day of moderate physical activity, coupled with a 5 to 10 percent reduction in body weight, produces a 58 percent reduction in the incidence of diabetes among people at risk (Sheard 2003). The American Diabetes Association recommends a diet high in fiber, unrefined carbohydrates, and low in saturated fat (Sheard 2004). Foods with a low glycemic index are especially recommended because they blunt the insulin response. In addition to diet and exercise, the prescription drug metformin has been proven to increase insulin sensitivity in people with mild to moderate hyperglycemia. Metformin is now the most commonly prescribed oral antidiabetic drug worldwide. It works by increasing insulin sensitivity in the liver (Joshi 2005). It also has a number of other beneficial effects, including weight loss, reduced cholesterol-triglyceride levels, and improved endothelial function.

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