Diabetes Drugs Tied To Pancreatic Cancer Risk
By Genevra Pittman, Reuters Health
6 Min Read
NEW YORK – A new study links the diabetes drug metformin to fewer cases of pancreatic cancer — at least in women — but finds other diabetes medications are associated with a higher risk of the disease.
The differences in medication history among people who did or didnt get pancreatic cancer were small, researchers said, and its unclear why the drugs might affect cancer risks in men and women differently.
Still, the new finding is in line with previous research suggesting that metformin may decrease the risk of multiple cancers, said Dr. Peter Butler, a diabetes researcher at the University of California, Los Angeles David Geffen School of Medicine, who wasnt involved in the new study.
One theme that seems to be coming through… is that the oldest drug we have for diabetes, metformin, is undoubtedly the best drug we have for diabetes, he told Reuters Health.
Pancreatic cancer is relatively rare as far as cancers go, but progresses quickly most people dont survive more than a couple years after diagnosis. The National Cancer Institute estimates that about 44,000 people will be diagnosed with pancreatic cancer in the United States this year, and close to 38,000 will die from the disease.
Research has suggested that people with pancreatic cancer may have an increased risk of diabetes, but its unclear how diabetes — and the drugs used to treat it — may affect pancreatic cancer risks in previously cancer-free people.
Drugs Used To Treat Pc May Cause Diabetes
A recently emerging issue is the possible adverse effect on glucose metabolism of anticancer therapies. Cancer patients commonly exhibit hyperglycemic states or DM following glucocorticoid administration . The increasing use of targeted chemotherapy directed against components of the IGF1 pathway may amplify the frequency of anticancer drug-related diabetes. IGF1 and insulin, their receptors, and their intracellular signaling pathways share multiple similarities. Likewise, the biological effects of insulin and IGFs overlap. Hyperglycemia was observed in some patients enrolled in studies with an anti-IGF1R antibody . This is likely to be a consequence of a compensatory increase in the circulating concentration of GH after IGF1 blockade, with the consequent increase in GH-induced insulin resistance . Hyperglycemia, hypertriglyceridemia, and hypercholesterolemia were also observed in about 20% of patients treated with the mTOR inhibitors . Recent reports also documented increased blood glucose levels in 26% of temsirolimus-treated patients . However, tyrosine kinase inhibitor therapy directed at IGF1Rs was associated with less hyperglycemia than IGF1R-blocking antibodies . At present, insufficient data are available to assess the possible diabetogenic effects of phosphoinositol-3-kinase and AKT inhibitor therapy.
Variables Derived From The Health Screening Exam Database
The participants of a government-operated health examination answered a questionnaire addressing demographic characteristics and lifestyle habits, such as smoking status, alcohol consumption, and exercise. Body mass index was calculated as weight in kilograms divided by the square of height in meters. BP was measured using a standardized sphygmomanometer after 5minutes of rest. Venous blood samples were collected in the morning after an overnight fast of at least 8hours. Serum levels of glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase were measured. Quality control procedures for laboratory tests have been conducted in accordance with the Korean Association of Laboratory Quality Control.
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/6sign Of Advanced Pancreatic Cancer
Pancreatic cancer is the twelfth most common cancer worldwide. Just like other types of cancers, pancreatic cancer is caused by the abnormal growth of cells in the pancreas. The pancreas is a small gland or organ situated behind the stomach that produces and releases substances in the body. It not only helps produce substances or enzymes that help with digestion, but also assists in releasing hormones that control the amount of sugar in your bloodstream. Having said that, pancreatic cancer can be extremely worrisome. The key however is to detect it as early as possible and to start treatment immediately.
Diabetes Mellitus As A Risk Factor For Pancreatic Cancer
Diabetes mellitus or glucose intolerance may be present in up to 75% of patients with pancreatic cancer, a figure much higher than in other cancer types in whom the prevalence is no more than 30% . The relationship between DM and pancreatic cancer is bi-directional, as studies point to both increased risk of pancreatic cancer in those with long-term diabetes, as well as greater incidence of diabetes in sync with the development of pancreatic cancer . Many studies evaluating DM as a risk factor have focused on patients with DM diagnosed several years prior to the time of pancreatic cancer diagnosis in order to exclude cases of DM that are a result of pancreatic cancer. This follows from the assumption that pancreatic cancer is rapidly fatal and therefore DM diagnosed several years prior to cancer diagnosis would unlikely be from the cancer .
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T2dm As A Risk Factor Of Pc
Epidemiological studies have demonstrated that T2DM is a risk factor of PC.1824 And many studies in the past 5 years have also proved that T2DM is the cause of PC. Risk associations between temporal pattern of risk and duration of T2DM given in five reports are plotted in Figure 1. It clearly shows that the shorter the duration of T2DM is, the higher the average risk associations between PC and T2DM are. Even if T2DM has lasted for 20 years, the hazard ratios or odds ratios between them are still greater than 1, thus proving that T2DM is a risk factor of PC.
Figure 1 Hazard ratio, odds ratio, or relative risk of pancreatic cancer by the duration of type 2 diabetes.Abbreviations: HR, hazard ratio OR, odds ratio RR, relative risk.
Bosetti C et al, analyzed individual-level data from 15 casecontrol studies within the Pancreatic Cancer Case-Control Consortium, including 1155 cases and 1087 controls that were diagnosed of T2DM 2 or more years before PC diagnosis, corresponding to an OR of 1.90 .25 And the study also demonstrated that the duration of T2DM was associated with decreased risk of PC, but there was still a significant excess risk between them 20 or more years after diabetes diagnosis , therefore supporting that T2DM could be a risk factor of PC.
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/6one Sign That Could Tell If The Cancer Has Spread
Depending on where the cancer has spread, the symptoms may vary. But one sign of spreading tumour is pain, according to Cancer Research UK.
The Charity describes the pain as gnawing and notes that it can be continuous – the cause being the breaking down of the living tissues that build the skeleton.
The area in the body that can be most affected is the back. The pain in this part of the body can be persistent, says the Charity.
However, according to the UK’s National Health Services , this backache can also occur when the cancer hasn’t even spread. The health body warns against a worsening pain when eating or lying down.
Associations Between Metformin Use And Mortality
Among individuals with PPDM, there were statistically significant differences in mortality risk across the metformin exposure groups in the main analysis . Never users of antidiabetic medications had the lowest survival probability, followed by metformin never users and metformin ever users . The differences in survival probabilities were statistically significant for all the pairwise comparisons . Compared with never users of antidiabetic medications, ever users of metformin had a significantly lower risk of mortality . The lower mortality risk associated with metformin use was more pronounced in individuals with PPDM compared with those with type 2 diabetes . There was no significant association between metformin use and cause-specific mortality in individuals with PPDM .
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What Does The Bmj Article Say About These Diabetes Drugs
Because incretin mimetics stimulate the cells of the pancreas, there is the potential that they may also have adverse effects on the organ.
Recently, experts have had increasing concerns about the safety of incretin mimetics. In February 2013 an independent analysis of health insurance data found that people taking exenatide and sitagliptin were at twice the risk of being admitted to hospital with inflammation of the pancreas compared with people taking other diabetic drugs.
The actual size of the risk to the individual was low only 0.6%, or six in every 1,000 people taking the drugs. But even if individual risk is low, health watchdogs have to consider the fact that these types of drugs are taken by hundreds of thousands of people.
In April 2013, analysis of data from the US Food and Drug Administration also showed increases in cases of pancreatitis and pancreatic cancer among people taking incretin mimetics compared with those taking other diabetic drugs.
Both the FDA and the European Medicines Agency are said to have confirmed to the BMJ that their own analyses also show increased reports of pancreatic cancer with these drugs.
However, the agencies have emphasised that this does not necessarily mean that the drugs directly cause these adverse effects. It could possibly be the case that it is type 2 diabetes itself, rather than the drugs, that is increasing the risk of pancreatic cancer.
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Why Is Type 3c Diabetes Different To Type 1 And Type 2
Type 3c diabetes is different to type 1 diabetes and type 2 diabetes.
- People with type 1 diabetes produce very little or no insulin, but normal levels of glucagon. People with type 3c diabetes produce less of all the hormones from the pancreas, including insulin and glucagon. If you have had your whole pancreas removed , you wont produce any insulin or glucagon.
- People with type 2 diabetes cant use the insulin their pancreas makes properly. People with type 3c diabetes can use the insulin but dont make enough of it. If their whole pancreas has been removed, they wont make any insulin.
The different types of diabetes need to be treated differently. This means that the usual treatment for type 1 or type 2 diabetes may not be right for you if you have pancreatic cancer. If you already had type 1 or type 2 diabetes before being diagnosed with pancreatic cancer, your diabetes may now need to be treated differently. Most people with type 3c diabetes will need to take medicine, which may be tablets or insulin injections.
You may find that type 3c diabetes isnt as well known as type 1 or type 2.A lot of the information you may find about diabetes is for people with type 1 or 2 diabetes, and may not be relevant to you. For example, there is a lot of information about losing weight for people with type 2 diabetes this wont be relevant to people with type 3c diabetes who have lost weight or are struggling to put weight back on.
What Should We Make Of All This
The conclusion is that its still not clear yet whether diabetes is a cause, or consequence, of pancreatic cancer. It seems likely that it can actually be either, depending on each individual case.
Whats important is that people affected by diabetes dont panic. Someone who has diabetes wont necessarily also develop pancreatic cancer.
In fact, less than 2 in 100 people with diabetes are diagnosed with pancreatic cancer in the 3 years after being told about their diabetes. And the more time that elapses after the diabetes diagnosis, the less likely it is that someone will develop pancreatic cancer although their risk is still a little higher than that of someone who doesnt have diabetes.
The number of pancreatic cancer cases is small, which means although a higher risk than the general population, a relatively small risk for people with diabetes, confirms Howarth.
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Information On Pancreatic Cancer
Unfortunately, pancreatic cancer is difficult to diagnose, and the diagnosis is often made late in the course of the disease. Early detection of pancreatic cancer is essential and will greatly improve a persons chances of surviving the disease. As such, people that have taken the drugs Byetta, Januvia, Janumet or Victoza, especially those with symptoms of weight loss, dark urine and clay-colored stools, back pain, and jaundice, should seek advice from a qualified medical professional as to if they may have pancreatic cancer and what symptoms they should be aware of to detect any early onset of pancreatic cancer.
/8what Is The Prevalence Of Type 1 Diabetes In India
This disease, which is a highly prevalent endocrine disorder in children, is widely seen in India.
According to data from the International Diabetes Federation, with 229,400 cases, India currently has the highest estimated prevalence of type 1 diabetes cases among people under the age of 20. Nearly 24000 new cases of type 1 diabetes are added every year.
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