Increasing cancer burden in older people with type 2 diabetes

By Melanie Hinze

Cancer prevention, detection and screening strategies should be tailored to address widening inequalities among patients with type 2 diabetes, new research suggests.

Published in Diabetologia, the population-based cohort study examined long-term trends in cancer mortality rates in 137,804 individuals aged 35 years or older who had newly diagnosed type 2 diabetes in the English Clinical Practice Research Datalink between January 1998 and November 2018.

Over a median follow up of 8.4 years, cancer mortality  rates decreased for individuals  aged 55 years and those aged 65  years, but increased among those aged 75 years and 85 years. Constant upward trends in mortality rates were seen for pancreatic, liver and lung cancer at all ages, colorectal cancer at most ages, prostate and endometrial cancer at older ages and breast cancer at younger ages. Compared with the general population, people with type 2 diabetes had a more than 1.5-fold increased risk of colorectal, pancreatic, liver and endometrial cancers.

The study authors also found persistent inequalities in cancer mortality trends by gender and socioeconomic status, but widening disparities for those who had ever smoked. Smokers experienced not only higher mortality rates but also increasing mortality trends during the study period.

Professor Jonathan Shaw, Deputy Director of Clinical and Population Health at the Baker Heart and Diabetes Institute and Professor in the School of Life Sciences at La Trobe University, Melbourne, said that important findings from this study confirmed results from other studies, including those conducted in Australia.

Professor Shaw, who is also Professor in the School of Public Health and Preventive Medicine at Monash University, Melbourne, told Medicine Today that overall, mortality among people with type 2 diabetes was declining. This was likely due to a combination of earlier diagnosis and better prevention and treatment of cardiovascular disease.

‘However, cancer has become at least as important as cardiovascular disease as a cause of death in people with type 2 diabetes,’ he said.

‘Ensuring that people with diabetes are up to date with all standard cancer screening programs is, therefore, very important.’

Professor Shaw added that health outcomes remained worse in people from more disadvantaged areas. ‘The effect of this is apparent in virtually every country in which it has been examined, irrespective of the way healthcare is funded, and is so strong that socioeconomic status appears in a number of cardiovascular risk equations,’ he said. 

Diabetologia 2023; https://doi. org/10.1007/s00125-022-05854-8.