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The Diabetes–Cancer Link: Coming to a Consensus

The Diabetes–Cancer Link: Coming to a Consensus

In 2009, allegations that insulin causes cancer grabbed headlines. Experts from the American Diabetes Association and American Cancer Society evaluated this relationship but could neither confirm nor deny it. “Many patients with diabetes stopped taking their medications because of these unfounded allegations,” says Yehuda Handelsman, MD, FACP, FACE, FNLA. Recently, a task force from the American Association of Clinical Endocrinologists and American College of Endocrinology reviewed the roles of obesity and diabetes and their therapies in the context of the pathogenesis of cancer and published a consensus statement on the topic in Endocrine Practice. Assessing the Link It may generally take as long as 10 to 50 years for cancer to develop after a cell is exposed to a carcinogen. “Many of the allegations suggesting that diabetes medications may be responsible for the development of cancer were based on exposure of 6 to 24 months, making their role unlikely,” says Dr. Handelsman. Many of the publications implicating insulin in the increased long-term cancer risk were based on retrospective data on 3 to 5 years of insulin exposure. The statement also notes that obese patients are at increased risk for cancer when compared with the general population, and patients with diabetes have a slightly higher risk of cancer than obese patients. As such, the task force recommends that patients with diabetes or obesity be screened early for cancer. It also recommends that young adults with cancer be screened for metabolic conditions. With no direct relationships between diabetes medication and cancer development being proven, Dr. Handelsman says there is no reason for physicians to change how they manage diabetes, and patients...

Treatment Trends for Type 2 Diabetes

The burden of diabetes is expected to increase over the next few decades in the United States, with about one in three American adults projected to be at risk for developing the disease by 2050. Diabetes has also been linked to a considerable economic burden, with annual direct medical expenditures for treating and managing the disease totaling nearly $250 billion in 2012. Most of the medical expenditures for diabetes are attributable to hospitalizations and physician services, but the costs of prescription therapies are also significant. With the high prevalence and burden of diabetes, the disease has become a ripe target for pharmaceutical development. “During the past decade, several important changes in the diabetes marketplace have occurred,” explains G. Caleb Alexander, MD, FACP. For example, in the early 2000s, glitazones were rapidly adopted for use, but subsequent evidence suggested that these agents were associated with cardiovascular risks. In turn, this led to substantial declines in the use of glitazones during the latter half of the decade.  In addition, new long-acting insulins and several new classes of therapies have emerged to treat type 2 diabetes, including injectable incretin mimetics such as glucagon-like peptide 1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium glucose cotransporter 2 (SGLT-2) inhibitors. The costs of these medications can be high, but clinicians appear to be interested in using them because of their novel mechanisms of action and potential promise in helping to improve glycemic control among those with type 2 diabetes.   Examining Recent Patterns Over the past 2 decades, clinical investigations have examined changes in the treatment of diabetes. These analyses identified several important trends,...
Takin’ It to the Streets: New Recommendations for Driving & Diabetes

Takin’ It to the Streets: New Recommendations for Driving & Diabetes

Nearly 19 million people in the United States have diagnosed diabetes, and many of these individuals will seek or presently hold a license to drive. Currently, states have different laws concerning driving and diabetes. “For people with diabetes, a driver’s license is essential for many reasons, including getting to and from work or school, caring for themselves and/ or family members, and many other daily life functions,” says Daniel Lorber, MD, FACP, CDE. “This is an important issue because there has been considerable debate on the role of diabetes and its relevancy on determining driver ability and eligibility for a license.” He adds that each state has its own laws on disclosure of diseases that may impact patients’ driving ability, further complicating the issue. Click here to view our new Diabetes Update ebook. Research suggests most people with diabetes can and do drive safely, but in the past, there have been inappropriate attempts to restrict driving licensure for these patients. “The chief concern about driving with diabetes is hypoglycemia because these episodes can cause confusion and disorientation,” Dr. Lorber says. However, while hypoglycemic episodes can affect driving ability, the available data show that these incidents are uncommon. Other factors related to diabetes that could affect driving include retinopathy and peripheral neuropathy.   New Guidance In the January 2012 issue of Diabetes Care, the American Diabetes Association released a position statement based on current scientific and medical evidence addressing the issue of driving in patients with diabetes. The statement advises against blanket restrictions and instead recommends that patients who have issues that could increase driving risks be assessed by physicians...

2012 ADA Annual Scientific Sessions

New research was presented at the American Diabetes Association’s 72nd Scientific Sessions from June 8-12, 2012 in Philadelphia. The features below highlight just some of the studies that emerged from the conference Heart & Cancer Risks With Insulin The Particulars: Previous research suggests that there may be an association between insulin use and an increased risk of myocardial infarction, stroke, and several types of cancer. However, the long-term impacts of insulin on serious cardiovascular outcomes and cancers in patients at high risk for type 2 diabetes have not been examined. Data Breakdown: A study randomized people at high risk for type 2 diabetes or in the early stages of it to daily insulin glargine injections or no insulin for an average of 6.2 years. No differences in cardiovascular outcomes or the development of any cancer type were observed in the two groups. Patients who received insulin maintained normal glucose levels (90 to 94 mg/dL) throughout the study. Take Home Pearl: Long-term use of insulin glargine in patients at high risk for type 2 diabetes or in the early stages of the disease does not appear to put them at greater risk of developing cardiovascular conditions or cancer. Type 1 & 2 Diabetes Prevalence Increasing in the Young The Particulars: For years, the prevalence of type 1 and type 2 diabetes has been increasing in younger people worldwide. Few data, however, have explored trends in both type 1 and type 2 disease in the United States among younger individuals. Data Breakdown: An analysis from the CDC and NIH found that the prevalence of type 2 diabetes increased 21%, and the...

Breast Cancer, Diabetes, & Outcomes

Diabetes and cancer are major causes of illness and death worldwide. The CDC has released a report showing that the prevalence of diabetes has increased to 25.8 million in America, or 8.3% of the national population. It’s estimated that 2.5 million of these individuals are survivors of breast cancer. Research has shown that diabetes increases the risk of breast cancer. Furthermore, two of the major risk factors for type 2 diabetes—older age and obesity—have also been associated with breast cancer. A concern for physicians managing patients who have diabetes and are diagnosed with breast cancer is that care for the preexisting diabetes often goes on the back burner; the breast cancer takes center stage. Patients may sometimes view their breast cancer diagnosis as a greater threat to their lives than their diabetes. Alarming Data on Breast Cancer-Diabetes Relationship In order to better understand the relationship between breast cancer and diabetes, my colleagues and I conducted a systematic review and meta-analysis of previous research. Published in the January 2011Journal of Clinical Oncology, our investigation looked in depth at eight studies involving patients with preexisting diabetes and breast cancer outcomes. Six of the studies reported a risk estimate effect on all-cause mortality in patients with breast cancer. We then qualitatively summarized other prognostic outcomes. When compared with those who did not have diabetes, women with breast cancer and preexisting diabetes had a 49% greater risk of death. “When compared with those who did not have diabetes, women with breast cancer and preexisting diabetes had a 49% greater risk of death.” Another important finding from our research was that three of four...
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