Diabetes, Glucose Control, Glucose Lowering Medications, and Cancer Risk: A 10-year Population-based Historical Cohort

This is a large nationwide population study, with 10 year follow-up, of the effect of diabetes, metabolic control and a large number of glucose-lowering medications, on total and site-specific cancer incidence and survival. The study is based on electronic medical records from the largest Israeli health maintenance organization in Israel, Clalit Health Services. 2,301,990 insurees age 21 years old or above at study entry, January 2002 will be included. Four study groups will be established according to the prevalence of diabetes and/or cancer on that date: neither diabetes nor cancer; prevalent diabetes but not cancer; prevalent cancer but not diabetes; both diabetes and cancer prevalence. Subjects free of diabetes at study entry will be followed for diabetes incidence, and all four groups will be followed until December 2012 for study outcomes. The cohort data file will be linked to the Israel National Cancer Registry for cancer morbidity. We will compare, after adjustment, all and site-specific cancer rates between individuals with and without diabetes; and investigate if metabolic control, as indicated by HbA1c and blood glucose levels, is related to cancer risk. Using time-dependent Cox proportionate hazard models, we will then evaluate differences in outcomes that associate with the use of one or a combination of glucose-lowering treatments, while stratifying by those who were already diagnosed with diabetes at study entry, and those diagnosed during follow-up. Data for a large number of potential confounding variables, including BMI, plasma glucose, HbA1c, hormone replacement therapy and comorbidities will help mitigate allocation bias. The accessibility and uniformity of the healthcare provided by Clalit Health Services, as well as data on cancer screening tests, will minimize the risk of surveillance bias.

Sex

All

Minimum age

21 Years

Maximum age

90 Years

Inclusion Criteria:

* Aged older than 21 and younger than 90 at study entry, January 1, 2002
* Insured by Clalit Health Services

Exclusion Criteria:

* Under age 21 at January 1, 2002
* Over age 90 at January 1, 2002

• BACKGROUNDDankner R, Balicer R, Boffetta P, Boker LK, Wallenstein S, Freedman L, Goldfracht M, Roth J, Tamler R, LeRoith D. Diabetes, glucose control, glucose lowering medications, and cancer risk: a 10-year population-based historical cohort. BMC Cancer. 2012 Aug 23;12:364. doi: 10.1186/1471-2407-12-364. PMID 22917080
• RESULTDankner R, Boffetta P, Keinan-Boker L, Balicer RD, Berlin A, Olmer L, Murad H, Silverman B, Hoshen M, Freedman LS. Diabetes, prostate cancer screening and risk of low- and high-grade prostate cancer: an 11 year historical population follow-up study of more than 1 million men. Diabetologia. 2016 Aug;59(8):1683-91. doi: 10.1007/s00125-016-3972-x. Epub 2016 May 17. PMID 27189066
• RESULTDankner R, Boffetta P, Balicer RD, Boker LK, Sadeh M, Berlin A, Olmer L, Goldfracht M, Freedman LS. Time-Dependent Risk of Cancer After a Diabetes Diagnosis in a Cohort of 2.3 Million Adults. Am J Epidemiol. 2016 Jun 15;183(12):1098-106. doi: 10.1093/aje/kwv290. Epub 2016 Jun 2. PMID 27257115
• DERIVEDDankner R, Murad H, Agay N, Olmer L, Freedman LS. Glucagon-Like Peptide-1 Receptor Agonists and Pancreatic Cancer Risk in Patients With Type 2 Diabetes. JAMA Netw Open. 2024 Jan 2;7(1):e2350408. doi: 10.1001/jamanetworkopen.2023.50408. PMID 38175642
• DERIVEDDankner R, Freedman LS, Gerstein HC, Roth J, Keinan-Boker L. Newly diagnosed type 2 diabetes may serve as a potential marker for pancreatic cancer. Diabetes Metab Res Rev. 2018 Sep;34(6):e3018. doi: 10.1002/dmrr.3018. Epub 2018 Jun 17. PMID 29673046