Increased Risk of Gastrointestinal Malignancy in Patients with Diabetes Mellitus and Correlations with Anti-Diabetes Drugs: A Nationwide Population-based Study in Taiwan

Chun-Chih Chiu; Chin-Chou Huang; Yu-Chun Chen; Tzeng-Ji Chen; Ying Liang; Shing-Jong Lin; Jaw-Wen Chen; Hsin-Bang Leu; Wan-Leong Chan

doi:10.2169/internalmedicine.52.8276

ORIGINAL ARTICLES

Increased Risk of Gastrointestinal Malignancy in Patients with Diabetes Mellitus and Correlations with Anti-Diabetes Drugs: A Nationwide Population-based Study in Taiwan

Chun-Chih Chiu, Chin-Chou Huang, Yu-Chun Chen, Tzeng-Ji Chen, Ying Liang, Shing-Jong Lin, Jaw-Wen Chen, Hsin-Bang Leu, Wan-Leong Chan

Author information

Chun-Chih Chiu
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Cardiovascular Research Center, National Yang-Ming University, Taiwan
Chin-Chou Huang
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan
Cardiovascular Research Center, National Yang-Ming University, Taiwan
Institute of Pharmacology, National Yang-Ming University, Taiwan
Yu-Chun Chen
Department of Family Medicine, Taipei Veterans General Hospital, Taiwan
Tzeng-Ji Chen
Department of Family Medicine, Taipei Veterans General Hospital, Taiwan
Institute of Hospital and Health Care Administration, National Yang-Ming University, Taiwan
Ying Liang
Healthcare and Management Center, Taipei Veterans General Hospital, Taiwan
Department of Nursing, Taipei Veterans General Hospital, Taiwan
Shing-Jong Lin
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan
Cardiovascular Research Center, National Yang-Ming University, Taiwan
Institute of Clinical Medicine, National Yang-Ming University, Taiwan
Jaw-Wen Chen
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan
Cardiovascular Research Center, National Yang-Ming University, Taiwan
Institute of Pharmacology, National Yang-Ming University, Taiwan
Hsin-Bang Leu
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Healthcare and Management Center, Taipei Veterans General Hospital, Taiwan
Cardiovascular Research Center, National Yang-Ming University, Taiwan
Institute of Clinical Medicine, National Yang-Ming University, Taiwan
Wan-Leong Chan
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Healthcare and Management Center, Taipei Veterans General Hospital, Taiwan

Keywords: diabetes mellitus, gastrointestinal malignancy

JOURNAL OPEN ACCESS

2013 Volume 52 Issue 9 Pages 939-946

DOI https://doi.org/10.2169/internalmedicine.52.8276

Details

Abstract

Objective Although the major cause of morbidity and mortality in patients with diabetes mellitus (DM) is cardiovascular disease, DM is also associated with certain site-specific cancers. However, whether DM is associated with an increased risk of cancer of the digestive tract remains undetermined. A nationwide, population-based database in Taiwan was analyzed to explore the relationship between DM and cancer of the digestive organs.
Methods From 2000 to 2007, a study cohort consisting of 39,515 patients with newly diagnosed diabetes without a previous diagnosis of gastrointestinal (GI) cancer was identified from the National Health Insurance Research Database in Taiwan. A control cohort of 79,030 age- and sex-matched non-diabetic subjects was selected to compare the occurrence of GI malignancies between the two groups. The association between the incidence of GI cancers and the use of glucose-lowering therapies was also investigated.
Results During the 7-year follow-up period, GI cancers developed in 929 diabetic patients (2.35%) and 1,126 subjects (1.42%) in the comparison cohort. DM was associated with a 2.75-fold (95% confidence interval (CI), 2.51-3.02) higher risk of developing GI malignancy. Among GI cancers, the incidences of stomach (adjusted hazard ratio (HR), 1.49; 95% CI, 1.16-1.92), liver (adjusted HR, 2.65; 95% CI, 2.29-3.07), colon (adjusted HR, 1.58; 95% CI, 1.28-1.94) and pancreatic cancers (adjusted HR, 4.35; 95% CI, 2.93-6.47) were significantly increased in the patients with DM. An analysis of the effects of various glucose-lowering therapies in the diabetic patients revealed the use of α-glucosidase inhibitors to be associated with a lower risk of hepatic cancer (adjusted HR, 0.62; 95% CI, 0.4-0.94). Thiazolidinedione (TZD) treatment was associated with lower stomach (adjusted HR, 0.11; 95% CI, 0.02-0.82) and hepatic cancer risks (adjusted HR, 0.46; 95% CI, 0.29-0.73), while sulfonylurea use was associated with a lower colon cancer risk (adjusted HR, 0.74; 95% CI, 0.51-1.09) and a higher pancreatic cancer risk (adjusted HR, 2.36; 95% CI, 1.21-4.61).
Conclusion Patients with DM have an increased risk of GI malignancy that may be affected by the use of different categories of glucose-lowering therapies.

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