Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Republic of Korea.
Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Republic of Korea.
BMJ Open Diabetes Res Care. 2024 Feb 27;12(1):e003696. doi: 10.1136/bmjdrc-2023-003696.
Diabetes mellitus is known to increase the risk of cancer. Fasting blood glucose (FBG) levels can be changed over time. However, the association between FBG trajectory and cancer risk has been insufficiently studied. This research aims to examine the relationship between FBG trajectories and cancer risk in the Korean population.
We analyzed data from the National Health Insurance Service-National Health Screening Cohort collected between 2002 and 2015. Group-based trajectory modeling was performed on 256,271 Koreans aged 40-79 years who had participated in health examinations at least three times from 2002 to 2007. After excluding patients with cancer history before 2008, we constructed a cancer-free cohort. The Cox proportional hazards model was applied to examine the association between FBG trajectories and cancer incidence by cancer type, after adjustments for covariates. Cancer case was defined as a person who was an outpatient thrice or was hospitalized once or more with a cancer diagnosis code within the first year of the claim.
During the follow-up time (2008-2015), 18,991 cancer cases were identified. Four glucose trajectories were found: low-stable (mean of FBG at each wave <100 mg/dL), elevated-stable (113-124 mg/dL), elevated-high (104-166 mg/dL), and high-stable (>177 mg/dL). The high-stable group had a higher risk of multiple myeloma, liver cancer and gastrointestinal cancer than the low-stable group, with HR 4.09 (95% CI 1.40 to 11.95), HR 1.68 (95% CI 1.25 to 2.26) and HR 1.27 (95% CI 1.11 to 1.45), respectively. In elevated-stable trajectory, the risk increased for all cancer (HR 1.08, 95% CI 1.02 to 1.16) and stomach cancer (HR 1.24, 95% CI 1.07 to 1.43). Significant associations were also found in the elevated-high group with oral (HR 2.13, 95% CI 1.01 to 4.47), liver (HR 1.50, 95% CI 1.08 to 2.08) and pancreatic cancer (HR 1.99, 95% CI 1.20 to 3.30).
Our study highlights that the uncontrolled high glucose level for many years may increase the risk of cancer.
糖尿病会增加癌症风险。空腹血糖（FBG）水平会随时间而变化。然而，FBG 轨迹与癌症风险之间的关联尚未得到充分研究。本研究旨在检验韩国人群中 FBG 轨迹与癌症风险之间的关系。
我们分析了 2002 年至 2015 年期间国家健康保险服务-国家健康筛查队列的数据。对 2002 年至 2007 年至少参加过 3 次体检的 256271 名年龄在 40-79 岁的韩国人进行了基于群组的轨迹建模。在排除 2008 年前有癌症病史的患者后，我们构建了一个无癌症队列。应用 Cox 比例风险模型，按癌症类型调整协变量后，检验 FBG 轨迹与癌症发病率之间的关联。癌症病例定义为在索赔的第一年，有 3 次门诊就诊或住院 1 次或更多次并伴有癌症诊断代码的人。
在随访期间（2008-2015 年），发现了 18991 例癌症病例。发现了 4 种血糖轨迹：低稳定（每次波的 FBG 平均值<100mg/dL）、升高稳定（113-124mg/dL）、升高高（104-166mg/dL）和高稳定（>177mg/dL）。与低稳定组相比，高稳定组多发性骨髓瘤、肝癌和胃肠道癌的风险更高，HR 分别为 4.09（95%CI 1.40 至 11.95）、HR 为 1.68（95%CI 1.25 至 2.26）和 HR 为 1.27（95%CI 1.11 至 1.45）。在升高稳定轨迹中，所有癌症（HR 1.08，95%CI 1.02 至 1.16）和胃癌（HR 1.24，95%CI 1.07 至 1.43）的风险均增加。在升高高组中，口腔癌（HR 2.13，95%CI 1.01 至 4.47）、肝癌（HR 1.50，95%CI 1.08 至 2.08）和胰腺癌（HR 1.99，95%CI 1.20 至 3.30）的风险也显著增加。
本研究强调，多年来不受控制的高血糖水平可能会增加癌症风险。
