Cancer detection rates following enrolment in a disease management programme for type 2 diabetes
Cancer detection rates following enrolment in a disease management programme for type 2 diabetes
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DOI：
10.1007/s00125-013-2947-4
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发表时间：
2013-09-01
期刊：
影响因子：
8.2
通讯作者：
Hense, H. W.
中科院分区：
文献类型：
--
作者：
Geier, A. S.;Wellmann, J.;Hense, H. W.
最近的前瞻性研究发现，糖尿病诊断后不久，癌症风险就会升高，这可能是由于确定性的增加所致。本研究调查了参加 2 型糖尿病疾病管理计划 (DMP-DM2) 后，特定部位的癌症风险是否也会增加。我们将 DMP-DM2 的记录与人群癌症登记数据关联起来。研究时间为 2003 年 6 月至 2009 年 12 月。使用一般来源人群的癌症发病率计算 DMP 入组后时间间隔的标准化发病率 (SIR)。此外，使用自然样条的泊松回归来评估糖尿病病程与时间相关的癌症发病率。在 163,738 人年的随访中，发现了 2,034 例首例浸润性癌症病例。胰腺癌风险主要在入组后第一年显着增加（SIR 1.62）；仅在 DMP-DM2 入组前不到 1 年诊断出糖尿病的患者中才会出现这种增加。在新诊断的糖尿病患者中，在加入 DMP-DM2 后的第一年，子宫内膜癌的风险同样增加，但此后迅速下降。肝癌、肺癌、结肠癌、乳腺癌和前列腺癌的发病率不存在时间依赖性。参加 DMP-DM2 似乎不会引起大多数癌症的确定偏差。癌症风险最初增加，尤其是胰腺癌，可能是由于反向因果关系的结果。在使用类似 DMP 的结构来研究糖尿病病程、降糖药物和癌症发病率之间的关联的环境中，确定偏差和癌症的时间依赖性发病率似乎不是什么问题。
Recent prospective studies found an elevated cancer risk shortly after diabetes diagnosis, and this was probably due to increased ascertainment. This study investigated whether site-specific cancer risks are also raised following enrolment in a disease management programme for type 2 diabetes mellitus (DMP-DM2).We linked records from a DMP-DM2 to population cancer registry data. The study period was from June 2003 to December 2009. Standardised incidence ratios (SIRs) were calculated for time intervals following DMP enrolment using the cancer incidence rates of the general source population. Additionally, Poisson regression with natural splines was used to assess time-dependent cancer incidence by diabetes duration.There were 2,034 first invasive cancer cases identified over 163,738 person-years of follow-up. Pancreatic cancer risk was significantly increased mainly in the first year after enrolment (SIR 1.62); the increment was only seen for patients in whom diabetes had been diagnosed less than 1 year before DMP-DM2 enrolment. Risk of endometrial cancer was similarly raised in the first year after DMP-DM2 enrolment among individuals newly diagnosed with diabetes but decreased rapidly thereafter. There was no time dependence in the incidence of cancers of the liver, lung, colon, breast and prostate.Enrolment in a DMP-DM2 did not appear to induce ascertainment bias for most cancers. Cancer risks were initially increased, especially for pancreatic cancer, potentially as a result of reverse causality. Ascertainment bias and time-dependent incidence of cancer appear to be less of a problem in settings using DMP-like structures for the study of the association between diabetes duration, glucose-lowering medication and cancer incidence.