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DOI: 10.1055/s-0029-1243193
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Diabetes Mellitus Type 2 – An Independent Risk Factor for Cancer?
Publication History
received 11.11.2009
first decision 11.11.2009
accepted 11.11.2009
Publication Date:
01 February 2010 (online)

Abstract
Epidemiological findings have shown up to two-fold increases in the risks of cancers of the colorectum, breast, endometrium, kidney (renal cell tumours), liver and pancreas among diabetes patients. In the present review, we address the question whether, on the basis of these epidemiological observations, type 2 diabetes should be considered a specific and independent risk factor for these various forms of cancer, due to its particular metabolic characteristics of glucose intolerance and hyperinsulinemia. On the basis of further epidemiological evidence among non-diabetic individuals, as well as recent studies examining the effects of different types of diabetes treatment on cancer risks, we conclude that chronic elevations in fasting and non-fasting blood levels of glucose and/or insulin are plausible independent risk factors for cancer, but that much of the increase in cancer risks associated with these two metabolic factors may occur within the normoglycaemic and insulinemic (non-diabetic) ranges. Furthermore, for some tumour types (e. g. cancer of the endometrium) the associations of risk with type 2 diabetes may to a large extent be due to, and at least partially confounded by, other obesity-related alterations in (e. g. sex steroid) metabolism that in part are independent of glucose and/or insulin metabolism. Specifically for pancreatic cancer, a major question, addressed in detail by other reviews, is whether associations of risk with plasma glucose, insulin or overt type 2 diabetes could be either a cause, or possibly also a consequence of tumour development (or both).
Key words
cancer - diabetes - metabolic features
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Correspondence
R. Kaaks
Division of Cancer
Epidemiology Deutsches Krebsforschungszentrum
Im Neuenheimer Feld 280
69120 Heidelberg
Germany
Phone: +49 6221 422 202
Fax: +49 6221 42 22 03
Email: r.kaaks@dkfz.de