Obesity and diabetes both linked to cancer

Diabetes and high BMI are leading causes of death and ill health globally and are on the increase in most countries. In 2014 9% of men and 8% of women worldwide had diabetes; 38.5% of men and 39.2% of women had high Body Mass Index (BMI), a figure equivalent to approximately 2 billion adults. 

A high BMI was responsible for almost twice as many cancers as diabetes. Over 5% of cancers worldwide were attributable to diabetes or high BMI in 2012, it is estimated that this proportion may increase by 25% by 2035 as a result of the global increase in obesity. 

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For countries such as the UK, an estimated 15% to 16% of cancers could be avoided by preventing diabetes, obesity or excess weight (defined as a BMI  greater than 25). A high BMI was responsible for almost twice as many cancers as diabetes.

Although the links between high BMI, diabetes and cancer have been known for some time, this study presents the first calculations of attributable risk for 175 countries. This represents the proportion of cancers that could be prevented if the risk factors were eliminated.  (The National Institute of Health Research NIHR)

The abstract is taken from NIHR

Abstract
Background
Diabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex.Methods We estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting.

Findings We estimated that 5·6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 792 600 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (626 900 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for twice as many cancer cases as diabetes (280 100 cases). 26·1% of diabetes-related cancers (equating to 77 000 new cases) and 31·9% of high BMI-related cancers (174 040 new cases) were attributable to increases in the prevalence of these risk factors from 1980 to 2002.

Interpretation A substantial number of cancer cases are attributable to diabetes and high BMI. As the prevalence of these cancer risk factors increases, clinical and public health efforts should focus on identifying optimal preventive and screening measures for whole populations and individual patients.

Full reference:  Pearson-Stuttard, J. et al |Worldwide burden of cancer attributable to diabetes and high body mass index: a comparative risk assessment|The Lancet Diabetes & Endocrinology|2017

The article can downloaded from The Lancet here 

Physical exercise may lower risk of developing diabetes in high risk individuals

University of Birmingham scientists in conjunction with Chinese researchers, studied  the incidence of  type 2 diabetes in a prospective cohort study of Chinese adults with impaired fasting glucose (IFG).44 828. The adults age range was between 20-80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed their health from 1996 to 2014.

The researchers  found an association between individuals who engage in physical activity and lower risk of diabetes, in people who have a high risk of developing the condition.  Studying an IFG population in Taiwan, compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume  leisure-time physical activity (LTPA) was reduced by 12%, 20%, and 25% respectively after adjusting for physical labour at work and other factors.

The researchers found that 19.2% of diabetes cases could have been avoided if the inactive participants had engaged in WHO recommendation levels of LTPA.

Full story from Science Daily 
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Abstract

Aims To evaluate the effects of habitual leisure-time physical activity (LTPA) on incident type 2 diabetes in a prospective cohort of Chinese adults with impaired fasting glucose (IFG).

Methods 44 828 Chinese adults aged 20–80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed up from 1996 to 2014. Incident type 2 diabetes was identified by fasting plasma glucose ≥7 mmol/L. The participants were classified into four categories based on their self-reported weekly LTPA: inactive, low, moderate, or high. Hazard ratios (HRs) and population attributable fractions (PAFs) were estimated with adjustment for established diabetic risk factor.

Results After 214 148 person-years of follow-up, we observed an inverse dose–response relationship between LTPA and diabetes risk. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA were reduced by 12% (HR 0.88, 95% CI 0.80 to 0.99; P=0.015), 20% (HR 0.80, 95% CI 0.71 to 0.90; P less than 0.001), and 25% (HR 0.75, 95% CI 0.67 to 0.83; P less than 0.001), respectively. At least 19.2% (PAF 19.2%, 95% CI 5.9% to 30.6%) of incident diabetes cases could be avoided if the inactive participants had engaged in WHO recommendation levels of LTPA. This would correspond to a potential reduction of at least 7 million diabetic patients in the Greater China area.

Conclusions Our results show higher levels of LTPA are associated with a lower risk of diabetes in IFG subjects. These data emphasise the urgent need for promoting physical activity as a preventive strategy against diabetes to offset the impact of population ageing and the growing obesity epidemic.

Full reference: Xiang, Q.L. et al | Increased leisure-time physical activity associated with lower onset of diabetes in 44 828 adults with impaired fasting glucose: a population-based prospective cohort study | British Journal of Sports Medicine| 2018 |DOI: 10.1136/bjsports-2017-098199

The full text article can be requested by Rotherham NHS staff here 

Increased risk of coronary artery disease for females with type 1 diabetes, according to Swedish study

Diabetes patients, who were diagnosed over three decades ago, were studied by scientists in Sweden. They found that females with type 1 diabetes may be at an increased risk of developing coronary artery disease.  (via Science Daily)

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The American Journal Diabetes Care has published an article based on the study, which analysed the the extent of coronary artery disease with coronary angiography in people with type 1 diabetes, most of which were conducted in the 1970s, 80s and 90s on seriously ill patients, revealing extensive constrictions of the coronary artery.

The researchers at Karolinska Institutet, Gothenburg University and Uppsala University conducted a large-scale study including all patients in Sweden — just short of 2,800 in number — with type 1 diabetes who had undergone coronary angiography between 2001 and 2013.  This sample comprised ,776 patients (42% women) with mean age 58 years (SD 11) were followed for 7.2 years (SD 2.2) The patients,  had had diabetes for an average of 35 years and had a mean age of 58. One fifth of the patients had normal coronary arteries, one fifth had one constricted artery, and about half had more than one.

 Viveca Ritsinger,  researcher at the Department of Medicine at Karolinska Institutet in Solna, expressed surprise at the findings, “we’d thought that more of the patients would have had extensive coronary artery disease after such a long time with diabetes, but one reason is the ongoing diabetes care we have in Sweden, whereby we’re better able to maintain normal sugar levels soon after disease onset and closely monitor other risk factors for cardiovascular disease.”

She also noted,  “generally speaking women develop coronary artery disease later and less extensively than men. Women with type 2 diabetes can, however, become afflicted earlier than women without diabetes. Our findings suggest that this also applies to women with type 1 diabetes.” (Science Daily)

Supporting the management of type 2 diabetes with pharmacist-led reviews and implementing NICE recommended nine key care processes (NICE Shared Learning)

A case study from Slough Clinical Commissioning Group (CCG)  has been published on NICE Shared Learning. 
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The case study looks at supporting the management of type 2 diabetes, using pharmacist- led reviews and implementing NICE’s nine key care processes annually.

These are:

  • Glycated haemoglobin (HbA1c) measurement, with a suggested target of 59 mmol/mol.
  • Blood pressure (BP) measurement, with a suggested target of 140/80 mm Hg.
  • Cholesterol level measurement, with a suggested target for total cholesterol (TC) of 5 mmol/L.
  • Retinal screening.
  • Foot checks.
  • Urinary albumin testing.
  • Serum creatinine testing.
  • Weight check.
  • Smoking status check.

Context: A pharmacist team worked with GP practices in Slough Clinical Commissioning Group (CCG) to identify patients missing any of the NICE-recommended 9 key care processes, or whose care processes indicated poor Type 2 Diabetes (T2D) control.

Aims: The project aimed to reduce the number of missing care processes and optimise pharmaceutical treatment (NICE Guideline 28) of patients whose treatment targets for glycated haemoglobin (HbA1c), blood pressure (BP) or total cholesterol (TC) readings were not being achieved.

Results: The proportion of patients receiving all the NICE-recommended 9 key care processes increased from 46% at project outset in April 2013 to 58% on completion in April 2014.

The percentage of patients achieving HbA1c, BP and TC targets all increased (65%-70%, 70%-76%, 78%-82%, respectively). Quality Outcomes Framework data for Slough CCG showed the percentage of diabetic patients achieving target HbA1c, BP and TC readings increased from April 2013 to April 2014, but then diminished in the year after project completion.

Key Findings:

  • Pharmacist-led reviews supported by a multidisciplinary team increased the number of key care processes administered and improved diabetic control during the year of programme delivery.
  • The project worked well as it combined the strategic drive and project facilitation skills of Slough CCG, the general practice teams’ knowledge of their patients and the clinical and information technology skills of an experienced pharmacist team and is a positive example of the ways in which multidisciplinary teams can work pro-actively to implement NICE guidance.
  • Whist the outcomes of the project were positive, the improvements diminished in the year following project completion, suggesting that such programmes should be ongoing rather than fixed term. This would be a key learning point for other organisations to consider when implementing a similar programme.

Further information is available from NICE Shared Learning

NHS Slough Clinical Commissioning Group| Supporting the management of type 2 diabetes with pharmacist-led reviews and implementing NICE recommended nine key care processes | February 2018 |NICE Shared Learning|

A paper regarding this project has been published on BMJ Open, it can be read here 

 

 

 

New link between bone cells and blood sugar level found

Scientists have  discovered a new mechanism that controls the link between bone cells and blood sugar level | Journal of Clinical Investigation | via ScienceDaily

As well as forming new bone, bone cells also influence the blood sugar level. Scientists have now discovered a new mechanism that controls this link.

The metabolism of bone cells determines how much sugar they use; if the bone cells consume more sugar than normal, this can lower the glucose level in the blood. This research may contribute to future therapies for conditions such as osteoporosis and diabetes.

Full story: Heavy bones, low body weight: New link between bone cells and blood sugar level found | ScienceDaily

Full reference: Dirckx, N et al. | Vhl deletion in osteoblasts boosts cellular glycolysis and improves global glucose metabolism | The Journal of Clinical Investigation | 2018

Type 2 diabetes can be reversed with very low-calorie diet

Study shows that it is possible to achieve remission from type 2 diabetes by dieting | The Lancet | via National Institute for Health Research

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Type 2 diabetes is a growing epidemic, costing the NHS £23.7 billion per year. By 2016 there were nearly 3.6 million people diagnosed with diabetes in the UK and a further one million estimated to have undiagnosed type 2 diabetes. Rates of diabetes appear to be increasing.

This study aimed to see if a very low-calorie diet program delivered in primary care could lead to at least 15kg weight loss and remission of type 2 diabetes.

The study found that by 12 months:

  • Weight loss of 15kg or more was achieved by 24% of the intervention group compared to none of the usual care group. Average weight loss was 10kg in the intervention group versus 1kg in the usual care group.
  • Diabetes remission occurred in 46% of the intervention group compared to 4% of the usual care group. It only occurred in people who had lost weight.
  • Remission was 20 times more likely with the intervention.
  • Better adherence to the regime increased the amount of weight loss and the chance of diabetes remission.
  • Diabetes medication did not need to be reintroduced for 74% of the intervention group. This was compared to 18% of the usual care group who were able to stop them. Blood pressure tablets were also no longer required for 68% of the intervention group compared to 39% of the usual care group.

Full reference: Lean MEJ, Leslie WS, Barnes AC, et al. |  Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.  | Lancet. 2017. [Epub ahead of print].

Night Shift Work and Type 2 Diabetes in the UK

New study looking at the connection between shift work and type 2 diabetes finds that more frequent night work increased the odds of type 2 diabetes, regardless of genetic type 2 diabetes risk. | Diabetes Care | via ScienceDaily

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A team of researchers examined data on hundreds of thousands of people in the UK Biobank to better understand how shift work — especially frequent night work — contributes to the likelihood of type 2 diabetes. The team also developed a genetic risk score for type 2 diabetes, examining genetic data for tens of thousands of workers in the database. They found that more frequent night work increased the odds of type 2 diabetes, regardless of genetic type 2 diabetes risk, among the population studied.

Those with the highest genetic risk scores were almost four times as likely to develop type 2 diabetes compared to individuals who had lower genetic risk scores. Those who reported working irregular or rotating shifts with usual night shifts were 44 percent more likely to have type 2 diabetes, after taking into account other established risk factors.

Full story at ScienceDaily

Full reference: Vetter, C et al. | Night Shift Work, Genetic Risk, and Type 2 Diabetes in the UK Biobank | Diabetes Care |  February 2018

Impact of chronic diseases on cancer risk

Several common chronic diseases together account for more than a fifth of new cancer cases and more than a third of cancer deaths| BMJ | via ScienceDaily

Findings from research published in the BMJ show that the cancer risks from common chronic diseases, such as heart disease and diabetes, are as important as those from five major lifestyle factors combined.

A team of researchers  investigated the combined effect of eight common chronic diseases or disease markers on cancer risk compared with lifestyle factors. Among the conditions evaluated were cardiovascular disease, diabetes, chronic kidney disease, pulmonary disease, and gouty arthritis.

The researchers found that cardiovascular disease markers, diabetes, chronic kidney disease markers, pulmonary disease, and gouty arthritis marker were individually associated with risk of developing cancer or cancer death.

Together, these chronic diseases and markers accounted for more than one fifth of all new cancers and more than one third of all cancer deaths in this study population, which was similar to the contribution of five major lifestyle risk factors combined — smoking, insufficient physical activity, insufficient fruit and vegetable intake, alcohol consumption, and obesity.

The researchers also found that physical activity was associated with a nearly 40% reduction in the excess risks of cancer and cancer death associated with chronic diseases and markers.

However, the authors point out that chronic diseases are not targeted in current cancer prevention strategies — and say their findings have important implications for developing new strategies that target chronic diseases.

Full detail at ScienceDaily

Full reference: Huakang Tu et al. |  Cancer risk associated with chronic diseases and disease markers: prospective cohort study | BMJ 2018

Pilot digital type 2 prevention programme fully rolled out

The digital stream of the NHS Diabetes Prevention Programme (NHS DPP) has now been fully rolled out across all eight pilot sites and the referral process has begun | Diabetes Times | NHS England

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The aim of this pilot is to establish whether digital interventions are effective in supporting behaviour change in those with non-diabetic hyperglycaemia (NDH) and overweight and or obese individuals who have not been diagnosed with NDH.

NHS England said early indications suggest that people have shown a keen interest in the digital behaviour change products that are on offer. The aim is for up to 5,000 people to be recruited over a six month period, with access to the digital interventions for up to 12 months. Data referral numbers and uptakes on the pilot will be available in the next couple of months.

Full story at The Diabetes Times

More on Digital innovations in diabetes at NHS England

New research suggests link between diabetes and brain function

New research shows diabetes is associated with long-term cognitive decline | Diabetologia | via Diabetes UK

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A study of older people in the UK suggests people with diabetes lose cognitive ability faster than people with normal blood sugar control.

The findings, published in Diabetologia, was led by researchers at Imperial College London. They studied more than 5,000 people over the age of 50 and measured their cognitive decline over a 10 year period.

The researchers measured cognitive decline by testing the memory and language skills of the participants. They repeated these tests every two years and monitored changes over time.

They included people with and without diabetes in the study, but didn’t find out which type of diabetes people had. They found that everyone performed worse on these tests as they aged. But in people with diabetes, this worsening (or cognitive decline) was quicker than in people who had normal blood glucose control. They also found that, whether people had diabetes or not, higher blood glucose levels were linked to poorer performance on the cognitive tests.

Full reference: Zheng, F., Yan, L., Yang, Z. et al.  |HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing | Diabetologia (2018) | published online 25th January 2018

More at Diabetes UK