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Incidence of Diabetes After Cancer DevelopmentA Korean National Cohort Study

Educational Objective
To learn the relationship between a cancer diagnosis and the subsequent incidence of diabetes.
1 Credit CME
Key Points

Question  Does cancer increase the risk of diabetes?

Findings  In a Korean general population cohort of 524 089 men and women observed for up to 10 years, participants who developed cancer had a clear increase in the subsequent risk of diabetes, even after taking into account precancer risk factors.

Meaning  Physicians should remember that patients with cancer develop other clinical problems, such as diabetes, with higher frequency than individuals without cancer, and should consider routine diabetes screening in these patients.

Abstract

Importance  Diabetes is an established risk factor for developing cancer. A limited body of evidence also suggests that cancer can increase the risk of developing new cases of diabetes, but the evidence is inconclusive.

Objective  To evaluate whether the development of cancer is associated with increasing risk of subsequent diabetes.

Design, Setting, and Participants  This cohort study included a nationally representative sample of the Korean general population observed for up to 10 years (January 1, 2003, to December 31, 2013). A total of 524 089 men and women 20 to 70 years of age without diabetes and with no history of cancer at baseline were included.

Exposures  Incident cancer (time-varying exposure).

Main Outcomes and Measures  Incident type 2 diabetes using insurance claim codes.

Results  During 3 492 935.6 person-years of follow-up (median follow-up, 7.0 years) in 494 189 individuals (50.0% female; mean [SD] age, 41.8 [12.5] years), 15 130 participants developed cancer and 26 610 participants developed diabetes. After adjustment for age, sex, precancer diabetes risk factors, metabolic factors, and comorbidities, the hazard ratio (HR) for diabetes associated with cancer development was 1.35 (95% CI, 1.26-1.45; P < .001). The excess risk for diabetes was highest in the first 2 years after cancer diagnosis, but it remained elevated throughout follow-up. By cancer type, development of pancreatic (HR, 5.15; 95% CI, 3.32-7.99), kidney (HR, 2.06; 95% CI, 1.34-3.16), liver (HR, 1.95; 95% CI, 1.50-2.54), gallbladder (HR, 1.79; 95% CI, 1.08-2.98), lung (HR, 1.74; 95% CI, 1.34-2.24), blood (HR, 1.61; 95% CI, 1.07-2.43), breast (HR, 1.60; 95% CI, 1.27-2.01), stomach (HR, 1.35; 95% CI, 1.16-1.58), and thyroid cancer (HR, 1.33; 95% CI, 1.12-1.59) was associated with a significantly increased risk of diabetes.

Conclusions and Relevance  In this large Korean cohort, cancer development increased the risk of subsequent diabetes. These data provide evidence that cancer is associated with an increased risk of diabetes in cancer survivors independent of traditional diabetes risk factors. Physicians should remember that patients with cancer develop other clinical problems, such as diabetes, with higher frequency than individuals without cancer, and should consider routine diabetes screening in these patients.

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Article Information

Accepted for Publication: April 2, 2018.

Corresponding Author: Juhee Cho, PhD, Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwonro, Gangnam, Seoul 06351, South Korea (jcho@skku.edu).

Published Online: June 7, 2018. doi:10.1001/jamaoncol.2018.1684

Author Contributions: Drs Kong and Cho had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Hwangbo and D. Kang contributed equally as co–first authors. Drs Kong and Cho contributed equally as co–senior authors.

Study concept and design: Hwangbo, D. Kang, S. Kim, Choi, Woo, Guallar, E. S. Lee, Kong, Cho.

Acquisition, analysis, or interpretation of data: Hwangbo, D. Kang, M. Kang, S. Kim, E. K. Lee, Y. Kim, Chang, Jung, Ahn, Sim, Hong, Pastor-Barriuso, Guallar, E. S. Lee, Cho.

Drafting of the manuscript: Hwangbo, D. Kang, M. Kang, S. Kim, Y. Kim, Chang, Choi, Sim, Hong, Guallar, E. S. Lee, Kong, Cho.

Critical revision of the manuscript for important intellectual content: Hwangbo, E. K. Lee, Jung, Woo, Ahn, Hong, Pastor-Barriuso, E. S. Lee, Kong, Cho.

Statistical analysis: D. Kang, M. Kang, S. Kim, Y. Kim, Hong, Pastor-Barriuso, Guallar, Cho.

Obtained funding: E. S. Lee, Kong.

Administrative, technical, or material support: Hwangbo, E. K. Lee, Chang, Choi, Sim, E. S. Lee, Cho.

Study supervision: Hwangbo, Choi, Jung, Woo, Sim, E. S. Lee, Kong, Cho.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by a grant from the Korean Ministry of Health and Welfare (1520240, E. S. Lee).

Role of the Funder/Sponsor: The Korean Ministry of Health and Welfare had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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