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Mark Greener reports on research linking type 2 diabetes to a widening cancer gap and rising risks of kidney disease and heart failure, plus the long-term effects of quitting smoking and of TIAs
People with type 2 diabetes (T2D) are more likely than the general population to develop cancer — and the gap is widening, according to Danish research presented during the annual meeting of the European Association for the Study of Diabetes in Milan.
“Our results underline the importance of considering cancer prevention and early detection alongside other aspects of diabetes care,” says study leader Dr Tinne Laurberg, Aarhus University Hospital.
Between 2010 and 2022, overall cancer incidence was 12% higher among men with T2D and 22% higher among women with the condition than in controls without diabetes. The gap has widened since 1996–2009, when the figures were 9% and 15% respectively.
The higher incidence was particularly marked in obesity-related cancers, which were 45% and 30% more common in men and women with T2D respectively in 2010–2022 than in controls. Postmenopausal breast cancer was 8% more common in women with T2D, and colorectal cancer 17% and 14% more common in men and women respectively.
Lung cancer was 23% and 25% more common in men and women with T2D respectively, but prostate cancer was 19% less common in men with T2D.
The study could not determine whether T2D causes the differences or assess factors such as body weight, smoking and alcohol consumption.
“These findings support greater recognition of cancer as a major long-term complication of T2D,” Laurberg concludes. “As outcomes for cardiovascular and kidney disease improve, cancer may require greater attention as part of long-term diabetes care.”
Diabetes risks increase “sharply over time”
The risk of chronic kidney disease (CKD), heart failure (HF) or death increases “sharply over time” after a diagnosis of T2D, according to research presented during the European Association for the Study of Diabetes meeting in Milan.
“Our findings clearly show how the serious complications associated with type 2 diabetes rise sharply over time as the common combination of obesity, abnormal blood fats, high blood pressure and higher blood sugar damages blood vessels and vital organs,” said Professor Naveed Sattar, University of Glasgow.
The study analysed real-world data for 1,617,508 US patients, mean age 59.3 years, who were newly diagnosed with T2D. Of these, 72.2% had dyslipidaemia and 68.4% had hypertension. The researchers are adding UK and Japanese data to the analysis.
Within five years of diagnosis, 32.9% of patients developed CKD or HF, or died. Within 10 years, this rose to 55.1%. In the first 5 years, the risk of developing CKD first was more than twice that of developing HF first (19.0% and 8.3% respectively). Of those who developed HF first, 42.0% developed CKD within the next 5 years, while 22.7% of those who developed CKD first went on to develop HF.
The study can neither prove causation nor exclude selection bias. “Our results emphasise the critical importance of detecting and treating type 2 diabetes thoroughly at the earliest opportunity to help reduce the risk of serious complications,” Sattar said.
Mini-strokes increase dementia risk
Transient ischaemic attacks (TIAs) are “associated with a large and sustained increase in dementia risk”, Canadian researchers report.
Researchers used records to match 113,081 patients with a first TIA to the same number of controls. Follow-up lasted for up to 21.3 years.
Dementia rates were 2.71 and 2.03 per 100 person-years in TIA patients and controls respectively. A TIA increased the risk of dementia by 75% within the first year compared with controls. The risk remained elevated by 46% within 5 years and 38% within 10 years.
The risk of dementia within the first year was 33% lower after a TIA than after a stroke, but the risks then converged: within 5 and 10 years it was 19% and 15% lower respectively. However, dementia was three times more common after a stroke than a TIA.
“Dementia occurs far more frequently after a TIA than [subsequently] having a stroke,” says study author Raed Joundi, McMaster University, Hamilton, Canada. “Prevention strategies after a TIA should go beyond stroke prevention and consider dementia as a major long-term complication.”
Long-term smoking cessation progressively reduces the risk of diabetic microvascular complications, according to a Korean study of 209,698 adults with type 2 diabetes.
Participants’ mean age was 57.2 years and 61.0% were female. The risk declined progressively with time but did not reach statistical significance until smokers had quit for 6 to 7 years.
Compared with continuous smokers, quitting for 6 to 7 years reduced the risk of all microvascular complications and diabetic neuropathy by 12% and 24% respectively. Quitting for at least 8 years reduced the risk of all microvascular complications by 19%, diabetic neuropathy by 20%, diabetic nephropathy by 21% and diabetic retinopathy by 41%.
The associations were more marked among males than females. However, small sample sizes limited female-specific analyses. The authors conclude that “further studies with adequate [statistical] power in women are warranted”.
They add that the benefits of quitting required “sustained, long-term cessation rather than appearing soon after quitting”.
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