Czyzyk A, Szczepanik Z
Department of Gastroenterology and Metabolic Diseases, Central Clinical Hospital, University Medical School of Warsaw, ul. Banacha 1A, PL-02-097, Warsaw, Poland
Eur J Intern Med. 2000 Oct;11(5):245-252. doi: 10.1016/s0953-6205(00)00106-0.
Although an association between diabetes and cancer was found over 100 years ago, the issue underwent different interpretations over the subsequent decades, and only modern, prospective, epidemiological cohort and case-control studies conducted in several countries have provided reliable evidence of an increased cancer risk in diabetic patients, mainly in those with type 2 diabetes. This risk varies according to the tumor site: it is the greatest for primary liver cancer, moderately elevated for pancreatic cancer, and relatively low for colorectal, endometrial, breast, and renal cancers. The cause of the association is not clear and remains the subject of different hypotheses. The most frequently cited reason is the potential effect of insulin. Found in high concentrations, due to insulin resistance in most patients with type 2 diabetes, this hormone is believed to express a mitogenic effect. This hypothesis needs to be confirmed in appropriately programmed prospective studies, but it may already be helpful in choosing an adequate treatment for type 2 diabetes to achieve optimal metabolic control with a simultaneous reduction in hyperinsulinemia, such as diet, physical exercise, metformin, and acarbose.
尽管100多年前就发现了糖尿病与癌症之间的关联，但在随后的几十年里，这个问题有着不同的解读，只有在几个国家开展的现代前瞻性流行病学队列研究和病例对照研究，才提供了可靠证据，证明糖尿病患者，主要是2型糖尿病患者患癌风险增加。这种风险因肿瘤部位而异：原发性肝癌风险最高，胰腺癌风险中度升高，结直肠癌、子宫内膜癌、乳腺癌和肾癌风险相对较低。这种关联的原因尚不清楚，仍然是不同假说的主题。最常被提及的原因是胰岛素的潜在作用。由于大多数2型糖尿病患者存在胰岛素抵抗，这种激素浓度很高，被认为具有促有丝分裂作用。这一假说需要在适当规划的前瞻性研究中得到证实，但它可能已经有助于为2型糖尿病选择适当的治疗方法，以实现最佳代谢控制，同时降低高胰岛素血症，如饮食、体育锻炼、二甲双胍和阿卡波糖。
