Diabetes, glycated hemoglobin and risk of cancer in the UK Biobank Study
Menée au Royaume-Uni à partir de données portant sur 476 517 personnes (54 % de femmes ; durée moyenne de suivi : 7,1 ans), cette étude analyse l'association entre les niveaux de diabète ou d'hémoglobine glyquée (HbA1C) et le risque de cancer, par localisation
Background: Evidence suggest that diabetes and glycated hemoglobin (HbA1c) levels are associated with cancer risk. However, previous studies have been limited variably by failure to adjust for cancer-specific risk factors (e.g., body mass index), inattention to diabetes duration and use of anti-diabetic medications, and failure to stratify by obesity. Methods: We examined the association between diabetes, HbA1c, and cancer risk in the UK Biobank, using data from 476,517 participants (54% women), followed for an average period of 7.1 years. Diabetes was defined based on baseline self-reported diagnosis of diabetes and/or use of diabetes medication, while HbA1c measured at baseline was categorized as low (<31mmol/mol), normal (31-<39mmol/mol), increased risk (39-<48mmol/mol), and high risk for diabetes (>=48mmol/mol). Multivariable Cox proportional hazards models were used to estimate the association of diabetes and cancer at different anatomical sites, with adjustment for cancer-specific risk factors. Results: Diabetes was associated with increased risk of cancers of the stomach, liver, bladder, endometrium, and lung among smokers, and with decreased risk of prostate cancer. Compared to the normal HbA1c category, the increased risk category was positively associated with risk of cancers of the colon, liver, bladder and lung among smokers, and the high risk category was associated with increased risk of cancers of the esophagus, liver, pancreas and bladder, and with decreased risk of prostate cancer. Conclusions: These results suggest that both diabetes and/or elevated HbA1c are associated with risk of cancer at several anatomical sites. Impact: The associations of diabetes and HbA1c levels with cancer suggest their importance in cancer prevention.