Diabetes, Obesity, Insulin Resistance: Different Pathways to Cancer?

Several studies have recently shaken the diabetes community, since there was some evidence that insulin glargine might enhance the rate of cancer among patients with diabetes [1] [2] [3] [4] [5] [6] [7].

While these studies, their weaknesses and their strengths have been discussed elsewhere [8] [9] [10] [11], we believe it to be important to our readers to gain an overview about the well-known connections between obesity, diabetes and cancer, as well as some deeper knowledge about the proliferative effects of insulin. Therefore, we have initiated a series of mini-reviews dealing with this issue. The first of these reviews, published in this issue of Experimental and Clinical Endocrinology & Diabetes, deals with the connection between obesity and cancer and the molecular mechanisms potentially linking these two different entities of disease [12]. Another will look at the epidemiologic observations about the coincidence of diabetes and malignancy. The next will explain insulin signal transduction in normal cells and its role in carcinogenesis, and last not least one mini-review will focus on the role of reactive metabolites, a cause of diabetic complications as well as tumour growth.

With these four mini-reviews we attempt to broaden and deepen the knowledge in this exciting and upcoming field, not only to understand why an increased incidence of cancer in patients with diabetes is not surprising, but also to understand why some of the studies published recently have severe weaknesses. On the other hand knowing about these details can help the physician to provide better care to patients with diabetes, care exceeding just glucose control and control of late diabetic complications, by having also the focus on prevention of cancer.

This will be presented to our readers as an ongoing effort to broaden the focus of Experimental and Clinical Endocrinology & Diabetes to areas such as obesity [13], metabolism-linked risk of cancer [14] [15] [16] atherosclerosis [17] [18] within the context of molecular mechanisms, but also practical guide to clinical decision making.

Prof. Dr. Peter Nawroth
PD Dr. Angelika Bierhaus

References

• 1 Hemkens LG, Grouven U, Bender R. et al . Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: A cohort study.  Diabetologia. 2009;  52 1732-1744
• 2 Currie CJ, Poole CD, Gale EA. The influence of glucose-lowering therapies on cancer risk in type 2 diabetes.  Diabetologia. 2009;  52 1766-1777
• 3 Jonasson JM, Ljung R, Talback M. et al . Insulin glargine use and short-term incidence of malignancies – a population-based follow-up study in Sweden.  Diabetologia. 2009;  52 1745-1754
• 4 Colhoun HM. Use of insulin glargine and cancer incidence in Scotland: A study from the Scottish Diabetes Research Network Epidemiology Group.  Diabetologia. 2009;  52 1755-1765
• 5 Home PD, Lagarenne P. Combined randomised controlled trial experience of malignancies in studies using insulin glargine.  Diabetologia. 2009; 
• 6 SDRN-Epidemiology-Group. . Use of insulin glargine and cancer incidence in Scotland: A study from the Scottish Diabetes Research Network Epidemiology Group.  Diabetologia. 2009; 
• 7 Idris I. Observational registry database studies link insulin glargine with cancer risk.  Diabetes Obes Metab. 2009;  11 910-912
• 8 Stumvoll M, Nawroth PP. The insulin glargine dilemma: an opportunity for the diabetes community?.  Diabetologia. 2009;  52 1987-1989
• 9 Gale EA. Insulin glargine and cancer: another side to the story?.  Lancet. 2009;  374 521
• 10 Gale EA. Collateral damage: the conundrum of drug safety.  Diabetologia. 2009;  52 1975-1982
• 11 Smith U, Gale EA. Does diabetes therapy influence the risk of cancer?.  Diabetologia. 2009;  52 1699-1708
• 12 Percik R, Stumvoll M. Obesity and Cancer.  Exp Clin Endocrinol Diabetes. 2009;  this issue 
• 13 Bluher M. Adipose tissue dysfunction in obesity.  Exp Clin Endocrinol Diabetes. 2009;  117 241-250
• 14 Monami M, Lamanna C, Pala L. et al . Treatment with insulin secretagogues and cancer-related mortality in type 2 diabetic patients a retrospective cohort study.  Exp Clin Endocrinol Diabetes. 2008;  116 184-189
• 15 Bruce WR, Wolever TM, Giacca A. Mechanisms linking diet and colorectal cancer: The possible role of insulin resistance.  Nutr Cancer. 2000;  37 19-26
• 16 Giovannucci E. Nutrition, insulin, insulin-like growth factors and cancer.  Horm Metab Res. 2003;  35 694-704
• 17 Rocha VZ, Libby P. Obesity, inflammation, and atherosclerosis.  Nat Rev Cardiol. 2009;  6 399-409
• 18 Greer JB, Whitcomb DC. Inflammation and pancreatic cancer: An evidence-based review.  Curr Opin Pharmacol. 2009;  9 411-418

Correspondence