Type 2 Diabetes Mellitus and Cancer: Epidemiology, Physiopathology and Prevention

Abstract

Individuals with type 2 diabetes mellitus are at greater risk of developing cancer and of dying from it. Both diseases are age-related, contributing to the impact of population aging on the long-term sustainability of health care systems in European Union countries. The purpose of this narrative review was to describe, from epidemiological, pathophysiological and preventive perspectives, the links between type 2 diabetes mellitus and the most prevalent cancers in these patients. Multiple metabolic abnormalities that may occur in type 2 diabetes mellitus, particularly obesity, could explain the increased cancer risk. In addition, the effectiveness of drugs commonly used to treat type 2 diabetes mellitus (e.g., metformin and thiazolidinediones) has been broadly evaluated in cancer prevention. Thus, a better understanding of the links between type 2 diabetes mellitus and cancer will help to identify the contributing factors and the pathophysiological pathways and to design personalized preventive strategies. The final goal is to facilitate healthy aging and the prevention of cancer and other diseases related with type 2 diabetes mellitus, which are among the main sources of disability and death in the European Union and worldwide.

Keywords: disease prevention; epidemiology; metformin; neoplasms; obesity; thiazolidinediones; type 2 diabetes mellitus.

Figure 1

Pathophysiological links between obesity/insulin resistance, type 2 diabetes mellitus, inflammation and cancer. Adapted from Cignarelli et al. [24].

Figure 2

Hazard ratios for death from cancer in high-risk locations in individuals with type 2 diabetes mellitus. Data extracted from the Asia Cohort Consortium (ACC) [20], Emerging Risk Factors Collaboration (ERFC) [17], Spanish Risk Function of Coronary Events and Others (FRESCO) [18] and National Health Research Institute (NHRI) [21]. * Includes all cancers located in female genital organs.