Abstract
Aims/hypothesis
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).
Methods
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.
Results
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.
Conclusions/interpretation
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.
Abbreviations
- DMP-DM2:
-
Disease management programme for type 2 diabetes mellitus
- SIR:
-
Standardised incidence ratio
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Acknowledgements
This work was supported by a grant from the German Cancer Aid (110482). We gratefully acknowledge the technical support of Hoffmann (AOK), Fricke (EKR), Liebeskind (InterForum). This study is a part of a PhD Project at the University of Münster.
Duality of interest
The authors declare that there is no duality of interest with this manuscript.
Contribution statement
HWH, HK and OH contributed to the acquisition of data and conception of the study. HWH, ASG, JW and IW contributed to the data analysis specification. HWH, ASG and GH contributed to the interpretation of data. All of the authors contributed to the critical revision of the article, and have all approved the final version of the paper.
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Geier, A.S., Wellmann, J., Wellmann, I. et al. Cancer detection rates following enrolment in a disease management programme for type 2 diabetes. Diabetologia 56, 1944–1948 (2013). https://doi.org/10.1007/s00125-013-2947-4
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DOI: https://doi.org/10.1007/s00125-013-2947-4