Diabetes treatment and canser occurense in diabetic patients

Both diabetes and cancer are prevalent diseases whose incidence is increasing globally. Epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer. Diabetes and cancer share many risk factors. Moreover, evidence from observational studies suggests that some medications used to treat hyperglycemia are associated with increased risk of cancer. The aim of the present study is that diabetes treatment regimes influence cancer risk or not.655 DM patients were referred to the hosbital of Düzce Univercity between january 2010 and january 2011, were enrolled in this study. Patients whose receiving pharmacologic diabetes therapies at least one year from the diagnose of diabetes, were assessed with physical examination, detailed medical history and laboratory test. At the firs visit, clinical information was recorded, including type of diabetes, age, sex, weight, height, BM?, occupation, smoking habits, comorbidity, family history, alcohol abuse ( consumption exceeding two drinks/day). HbA1c value recorded during the last 3 months and chest radiograph was analysed. Date of diagnosis of diabetes mellitus, date of initiatin diabetes treatment, type of pharmacologic diabetes therapies and date of changes in pharmacotherapy was optained. Patients were divided into two different groups whether they used oral agent or insulin and taking metformin or not taking metformin. Insulin users were grouped according to insulin regims, intensive insulin therapy, basal insulin therapy and mixed insulin therapy. Also insulin user were grouped according to treatment insulin glargine, insulin detemir, human insulin, biphasic analogue insulin. Cancer and benign tumor cases were identified at the first visit. And if there was a cancer suspicion, clinical examination was made for clearing the diagnose. Association between cancer, benign tumor and duration of diabetes treatment was evaluated. Patients who have not administrative data of cancer or benign tumor and diagnosis of cancer before date of diagnosis of diabetes mellitus, were excluded from the study.Total 655 DM patients whose 13 (%2) with Tip 1 diabetes, 642 (%98) with Tip 2 diabetes ( 379 (%58) women, 276 (%42) men) were enrolled in this study. Total number of 36 cansers ( 4 clorectal, 1 lung, 4 larinx, 1 biliary duct, 5 breast, 4vprostate, 4bladder, 3 leukemia/lymphoma, 1 female urogenital, 2 hepatic, 5 thyroid, 1 renal, and 1 unknown origin) and 76 benign tumors were observed.Patients with a cancer and without a cancer were compared with diabetes treatment regimes and type of pharmacologic agents. No significant differences was observed between groups using oral agent or insulin (p:0.429). And no differences between taking metformin and not taking metformin (p:0.119). Also no significant differences was observed between groups using intensive insulin therapy, basal insulin therapy or mixed insulin therapy regimes (p:0.059) and using insulin glargine, insulin detemir, human insulin or biphasic analogue insulin (p:0.418).Patients with a benign tumor and without a benign tumor were compared with diabetes treatment regimes. No significant differences was observed between groups using oral agent or insulin (p:0.709). In patient taking metformin compared with not taking metformin, metformin use was associated lower benign tumor, significant difference was observed (p:0.041). Groups were compared with insulin therapy, no significant difference was observed for insulin therapy regims (p:0.858) or for type of insulin (p:0.588).We evaluate the assosiation between diabetes treatment regimes and cancer in this study. Using oral agent or insulin, taking metformin or not taking metformin, using insulin glargine or the other type of insulin was not assosiated with cancer occurance. But in subgroup analysis, patients with using metformin had low occurance of benign tumor compared with not using metformin. Association of between DM and cancer is complex and it is extremely difficult to assess the independent association between a specific medications and cancer risk. Given these reasons, multipl long term follow up studies are needed.KEYWORDS, diabetes mellitus, cancer, insulin, insulin glargine, metformin