20 years of research on Chinese diabetic patients: high risk of cancer, obesity, blood sugar fluctuations are the incentives!

▎WuXi AppTec content team editor According to the global diabetes map released by the International Diabetes Federation (IDF) in 2021, there are 537 million adults with diabetes in the world aged 20-79, and the number of adults with diabetes in China has reached 141 million.
The rate is as high as 13%
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 Previous studies have shown that diabetes is associated with cancer risk, and cancer is becoming the leading cause of death in patients with diabetes.
In addition to prostate cancer, patients with diabetes have a 1.
5- to 2-fold increased risk of developing systemic cancers
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In obese patients with fluctuating blood sugar, weight loss and blood sugar reduction may reduce their risk of cancer
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 A study published today in The Lancet Regional Health-Western Pacific adds new insights into the link between blood sugar fluctuations (variability) and obesity and cancer in people with diabetes.
evidence
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This study from the Chinese University of Hong Kong team shows that if diabetic patients have large blood sugar fluctuations or are obese, the risk of cancer, especially breast cancer and liver cancer, and the risk of death are significantly increased
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Screenshot source: The Lancet Regional Health Western Pacific In this prospective cohort study, researchers used COX proportional hazards models to assess the association of glycemic variability with cancer of all sites (primary outcome of the study) and death from cancer-specific causes (secondary outcome of the study) The risk association of obesity and blood sugar fluctuations were also explored
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Glycated hemoglobin (HbA1c) is one of the criteria for diabetes diagnosis and blood sugar control recommended by the World Health Organization (WHO)
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In this study, the degree of glycemic variability (glycemic variability) was assessed with the HbA1c Variability Score (HVS), which was defined as the number of times the HbA1c value changed by 0.
5% from the previous visit
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 The study included 15,286 Chinese patients with diabetes duration ≥10 years, observation time ≥3 years, and at least 5 HbA1c measurements
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Among them, there were 15,054 patients with type 2 diabetes, accounting for 98.
5%; 232 patients with type 1 diabetes; 51.
7% of the patients were male, the average age was 61.
04 years, the average HbA1c: 7.
54%, and the average body mass index (BMI): 25.
65 kg/ m2; 928 patients with cancer of all sites, of which 404 died of cancer
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 Obesity, large blood sugar fluctuations, and high risk of cancer were analyzed.
It was found that there was a non-linear relationship between specific HVS values ​​and cancer outcomes, but after stratification by the median HVS (42.
31), the high HVS group and the low HVS group were significantly different from each other.
There was a linear relationship between cancer outcomes; in the high HVS group, each standard deviation increase in HVS was associated with a 15% increased risk of cancer at all sites and a 44% increased risk of breast, liver, and colorectal cancer, respectively.
37 % and 9%; the risk of cancer death, vascular death, and non-cancer non-vascular death increased by 21%, 27%, and 15%, respectively; if the body mass index ≥ 25 kg/m2 was used as the diagnostic criterion for obesity, it was further distinguished from low HVS.
Compared with non-obese patients, high HVS and obese patients had a 42%, 1.
44-fold, and 1.
63-fold increase in the risk of all-site cancer, breast cancer, and liver cancer, respectively, and increased risk of cancer death, vascular death, and non-cancer non-vascular death, respectively.
45%, 47%, 35%; in sensitivity analyses, these associations remained unchanged regardless of disease duration and number of HbA1c measurements
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Image source: 123RF In conclusion, obesity and high glycemic variability are associated with an increased risk of cancer of all sites, breast cancer, liver cancer, and cancer-specific death in patients with diabetes
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The paper points out that it is worth noting that about a quarter of all diabetic patients belong to a high-risk group with both obesity and blood sugar fluctuations
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The results suggest that optimizing blood sugar and weight control to reduce the risk of cancer development and cancer death is practical, especially in patients with poor and fluctuating blood sugar control
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Therefore, identifying these high-risk patients for intensive management will have important implications for individual health
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The comprehensive control goal of type 2 diabetes "China Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition)" pointed out that T2DM patients often have one or more components of the metabolic syndrome, such as hypertension, dyslipidemia, obesity, etc.
, which make T2DM complications.
The risk of occurrence, the speed of progression and the harm have increased significantly
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Therefore, a scientific and reasonable T2DM treatment strategy should be comprehensive, including the control of blood sugar, blood pressure, blood lipids and body weight, and antiplatelet therapy should be given when indicated
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The control of blood sugar, blood pressure, blood lipids and body weight should be based on the improvement of life>
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Image source: 123RF Blood Glucose Control and Weight Management Strategies Blood sugar control is of great significance in the metabolic management of diabetes
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HbA1c is the most important indicator to reflect the status of blood sugar control
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The setting of HbA1c control targets should take into account the balance between macrovascular and microvascular benefits and the risk of adverse reactions (hypoglycemia, weight gain, etc.
)
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The recommended HbA1c target for most nonpregnant adults with T2DM is <7%
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 Reasonable weight management in overweight and obese T2DM patients can not only improve blood sugar control and reduce the use of hypoglycemic drugs, but some diabetic patients can also stop hypoglycemic drugs and achieve a state of "remission" of diabetes
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 The weight management of diabetic patients should also follow the principle of individualization, that is, comprehensive consideration should be given according to the patient's age, course of disease, life expectancy, and the severity of complications or comorbidities
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Weight management strategies for overweight and obese adults with T2DM include life>
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Related reading "The Lancet" sub-issue in-depth: Diabetes "sugar control concept" to change! 3 major indicators, 2 new technologies, and 4 new treatments are worth paying attention to in The Lancet! Changes in the concept of diabetes treatment: weight control should be the primary treatment goal! The compliance rate is less than 20%! AHA's latest call: diabetic patients, need to pay attention to these 7 types of "heart protection" strategies! JAMA latest: Over 50% of Chinese adults have diabetes or are in the pre-disease stage! This "three lows" phenomenon is worrying! ADA's latest diabetes guidelines: It is recommended that everyone start screening at the age of 35, and metformin may not be the "first choice".
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Reference [1] Diabetes Society of Chinese Medical Association.
China Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition) [J].
Chinese Journal of Diabetes .
2021, 13(4):317-411.
[2] DandanMao, Eric SH Lau, Baoqi Fan et al.
, (2021).
Risk associations of long-termHbA1c variability and obesity on cancer events and cancer-specific death in15, 286 patients with diabetes - A prospective cohort study.
The Lancet RegionalHealth Western Pacific.
DOI: https://doi.
org/10.
1016/j.
lanwpc.
2021.
100315 Disclaimer: The WuXi AppTec content team focuses on global biomedical health research progress
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This article is for information exchange purposes only.
The views expressed in this article do not represent WuXi AppTec's position, nor do they represent WuXi AppTec's support or opposition to the views expressed in the article.

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This article is also not a treatment plan recommendation
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For guidance on treatment options, please visit a regular hospital
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