Malignancies in patients with insulin-treated diabetes mellitus.
In patients with diabetes mellitus, contradictory results have been reported indicating both increased and reduced risks of malignancies. In the present trial all insulin-treated diabetic patients (n = 2720) attending our centre since 1995 were studied. Of these patients, 28 (type 1/type 2: n = 1/27, 23 women) developed malignancies during insulin therapy: 11 patients developed cancer of the breast, 4 patients cancer of the pancreas, 3 patients cancer of the kidneys and 10 patients developed other malignancies. The characteristics of these patients [mean +/- SD (range)] were as follows: age 68.8 +/- 8.6 (52.0 87.0) years, diabetes duration 13.1 +/- 8.1 (0.5-29.0) years, duration of insulin therapy at the time of the diagnosis of malignancy 4.3 +/- 5.7 (0.5 24.0) years, insulin dosage 0.67 +/- 0.43 (0.11-1.72) IU/kg body weight, mean HbAlc 9.6 +/- 1.9 (6.8-14.9)% (HPLC, Diamat, normal range 4.4%-5.9%). The prevalences of nephropathy, retinopathy (non-proliferative: n = 7) and peripheral neuropathy were 35.7%, 25.0% and 46.4% respectively. When the features of the 27 patients with type 2 diabetes were compared with the characteristics of the type 2 diabetic patients (n = 117, 63 women) studied in a population-based survey of insulin-treated diabetic patients, also performed in the area of Jena [JEVIN; Schiel R et al. (1997a)] there were no significant differences in the duration of insulin therapy (JEVIN: 4.7 +/- 4.3 years, P = 0.64), insulin dosage (JEVIN: 0.55 +/- 0.27 IU/kg body weight, P = 0.08), mean HbAlc (JEVIN: 9.0 +/- 2.1%, P = 0.16) and the prevalences of long-term complications of diabetes. The quality of diabetes control in insulin-treated patients suffering from malignancies is comparable to that of a selection-free population of diabetic patients. Furthermore, in comparison to non-diabetic subjects our diabetic patients showed no altered risk for malignancies as a function of insulin dosage, the duration of diabetes or insulin therapy, the quality of diabetes control or the prevalence of long-term complications of the disease.
Friedrich-Schiller University, Department of Internal Medicine II, Jena, Germany.
R
R
Kath
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Schiel
U A
UA
Müller
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Höffken
D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D011159:Population Surveillance; D015995:Prevalence; D012306:Risk; D013997:Time Factors
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin