Pandey A, Forte V, Abdallah M, Alickaj A, Mahmud S, Asad S, McFarlane S I
Department of Medicine, SUNY Downstate Medical Centre, New York, USA.
Minerva Endocrinol. 2011 Sep;36(3):187-209.
Although diabetes has been known to increase the risk of cancer for over a century, it was not until recently when this area gained momentum and generated a lot of interest. That is in- part because of the rising global diabetes epidemic and the wide spread use of insulin analogues, metformin and other anti-diabetic agents, providing hypothesis generating data on the cancer risk in the diabetic population. Type 2 diabetes is associated with increased risk of breast, colon, pancreatic and other types of cancer, while type 1 diabetes is associated with increase in stomach, pancreatic, endometrial and cervical cancer. Mechanisms postulated for increased cancer risk in diabetes include hyperglycemia, hyperinsulinemia with stimulation of IGF-1 axis, obesity that serves as a common soil hypothesis for both cancer and diabetes as well as other factors such as increased cytokine production. More recently some antidiabetic agents have been thought to increase cancer risk such as insulin glargine, while metformin appears to lower cancer risk. In this review, we present the evidence for the link between diabetes and cancer highlighting the general mechanisms proposed for such a link as well as specific hypotheses for individual cancer. We will also discuss the role of insulin, metformin and other antidiabetic agents in cancer risk.
尽管一个多世纪以来人们都知道糖尿病会增加患癌风险，但直到最近这个领域才开始蓬勃发展并引发了广泛关注。部分原因在于全球糖尿病流行趋势的上升以及胰岛素类似物、二甲双胍和其他抗糖尿病药物的广泛使用，这些为研究糖尿病患者的癌症风险提供了假设生成数据。2型糖尿病与乳腺癌、结肠癌、胰腺癌及其他类型癌症的风险增加有关，而1型糖尿病与胃癌、胰腺癌、子宫内膜癌和宫颈癌的风险增加有关。推测糖尿病患者癌症风险增加的机制包括高血糖、刺激胰岛素样生长因子-1轴的高胰岛素血症、作为癌症和糖尿病共同土壤假说的肥胖以及其他因素，如细胞因子产生增加。最近，一些抗糖尿病药物被认为会增加癌症风险，如甘精胰岛素，而二甲双胍似乎能降低癌症风险。在这篇综述中，我们展示了糖尿病与癌症之间联系的证据，强调了为此类联系提出的一般机制以及个别癌症的具体假说。我们还将讨论胰岛素、二甲双胍和其他抗糖尿病药物在癌症风险中的作用。
