CARING (CAncer Risk and INsulin analoGues): the association of diabetes mellitus and cancer risk with focus on possible determinants - a systematic review and a meta-analysis

TY - JOUR

T1 - CARING (CAncer Risk and INsulin analoGues)

T2 - the association of diabetes mellitus and cancer risk with focus on possible determinants - a systematic review and a meta-analysis

AU - Starup-Linde, Jakob

AU - Karlstad, Oystein

AU - Eriksen, Stine Aistrup

AU - Vestergaard, Peter

AU - Bronsveld, Heleen K

AU - de Vries, Frank

AU - Andersen, Morten

AU - Auvinen, Anssi

AU - Haukka, Jari

AU - Hjellvik, Vidar

AU - Bazelier, Marloes T

AU - Boer, Anthonius de

AU - Furu, Kari

AU - De Bruin, Marie L

PY - 2013/12

Y1 - 2013/12

N2 - BACKGROUND: Patients suffering from diabetes mellitus (DM) may experience an increased risk of cancer; however, it is not certain whether this effect is due to diabetes per se.OBJECTIVE: To examine the association between DM and cancers by a systematic review and meta-analysis according to the PRISMA guidelines.DATA SOURCES: The systematic literature search includes Medline at PubMed, Embase, Cinahl, Bibliotek.dk, Cochrane library, Web of Science and SveMed+ with the search terms: "Diabetes mellitus", "Neoplasms", and "Risk of cancer".STUDY ELIGIBILITY CRITERIA: The included studies compared the risk of cancer in diabetic patients versus non-diabetic patients. All types of observational study designs were included.RESULTS: Diabetes patients were at a substantially increased risk of liver (RR=2.1), and pancreas (RR=2.2) cancer. Modestly elevated significant risks were also found for ovary (RR=1.2), breast (RR=1.1), cervix (RR=1.3), endometrial (RR=1.4), several digestive tract (RR=1.1-1.5), kidney (RR=1.4), and bladder cancer (RR=1.1). The findings were similar for men and women, and unrelated to study design. Meta-regression analyses showed limited effect modification of body mass index, and possible effect modification of age, gender, with some influence of study characteristics (population source, cancer- and diabetes ascertainment).LIMITATIONS: Publication bias seemed to be present. Only published data were used in the analyses.CONCLUSIONS: The systematic review and meta-analysis confirm the previous results of increased cancer risk in diabetes and extend this to additional cancer sites. Physicians in contact with patients with diabetes should be aware that diabetes patients are at an increased risk of cancer.

AB - BACKGROUND: Patients suffering from diabetes mellitus (DM) may experience an increased risk of cancer; however, it is not certain whether this effect is due to diabetes per se.OBJECTIVE: To examine the association between DM and cancers by a systematic review and meta-analysis according to the PRISMA guidelines.DATA SOURCES: The systematic literature search includes Medline at PubMed, Embase, Cinahl, Bibliotek.dk, Cochrane library, Web of Science and SveMed+ with the search terms: "Diabetes mellitus", "Neoplasms", and "Risk of cancer".STUDY ELIGIBILITY CRITERIA: The included studies compared the risk of cancer in diabetic patients versus non-diabetic patients. All types of observational study designs were included.RESULTS: Diabetes patients were at a substantially increased risk of liver (RR=2.1), and pancreas (RR=2.2) cancer. Modestly elevated significant risks were also found for ovary (RR=1.2), breast (RR=1.1), cervix (RR=1.3), endometrial (RR=1.4), several digestive tract (RR=1.1-1.5), kidney (RR=1.4), and bladder cancer (RR=1.1). The findings were similar for men and women, and unrelated to study design. Meta-regression analyses showed limited effect modification of body mass index, and possible effect modification of age, gender, with some influence of study characteristics (population source, cancer- and diabetes ascertainment).LIMITATIONS: Publication bias seemed to be present. Only published data were used in the analyses.CONCLUSIONS: The systematic review and meta-analysis confirm the previous results of increased cancer risk in diabetes and extend this to additional cancer sites. Physicians in contact with patients with diabetes should be aware that diabetes patients are at an increased risk of cancer.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Child

KW - Child, Preschool

KW - Diabetes Complications

KW - Diabetes Mellitus

KW - Humans

KW - Hypoglycemic Agents

KW - Infant

KW - Insulin

KW - Middle Aged

KW - Neoplasms

KW - Publication Bias

KW - Regression Analysis

KW - Risk

KW - Young Adult

KW - Journal Article

KW - Meta-Analysis

KW - Research Support, Non-U.S. Gov't

KW - Review

M3 - Journal article

C2 - 24215312

SN - 1574-8863

VL - 8

SP - 296

EP - 332

JO - Current Drug Safety

JF - Current Drug Safety

IS - 5

ER -