TY - JOUR
T1 - Incident Early-and Later-Onset Type 2 Diabetes and Risk of Early-and Later-Onset Cancer
T2 - Prospective Cohort Study
AU - Zhang, Yin
AU - Song, Mingyang
AU - Cao, Yin
AU - Eliassen, A. Heather
AU - Wolpin, Brian M.
AU - Stampfer, Meir J.
AU - Willett, Walter C.
AU - Wu, Kana
AU - Ng, Kimmie
AU - Hu, Frank B.
AU - Giovannucci, Edward L.
N1 - Funding Information:
Acknowledgments. The authors thank all participants and staff of the NHS and NHS II for the contributions to this research. The authors also acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention’s National Program of Cancer Registries and/or the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. Central registries may also be supported by state agencies, universities, and cancer centers. Participating central cancer registries include the following: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Maine, Maryland, Michigan, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Seattle SEER Registry, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, and Wyoming. Funding. The NHS was supported by National Institutes of Health (NIH) grants UM1 CA186107 and P01 CA87969 to M.J.S. and A.H.E. The NHS II was supported by NIH grant U01 CA176726 to W.C.W. and A.H.E. This work was additionally supported by the American Cancer Society Mentored Research Scholar Grant MRSG-17-220-01-NEC and NIH grant R00 CA215314 to M.S.; NIH grant R37 CA246175 to Y.C.; Lustgarten Foundation dedicated laboratory program, Dana-Farber Cancer Institute Hale Family Center for Pancreatic Cancer Research, NIH grants U01 CA210171 and P50 CA127003, Pancreatic Cancer Action Network, Stand Up to Cancer, Noble Effort Fund, Wexler Family Fund, Promises for Purple, and Bob Parsons Fund to B.M.W.; and NIH grant R01 CA205406 and Project P Fund to K.N. Y.Z. was supported by the Irene M. & Fredrick J. Stare Nutrition Education Fund Doctoral Scholarship and Mayer Fund Doctoral Scholarship.
Publisher Copyright:
© 2022, American Diabetes Association Inc. All rights reserved.
PY - 2023/1
Y1 - 2023/1
N2 - OBJECTIVE We evaluated prospectively the association between incident early-onset (diag-nosed before 40 years of age) and later-onset type 2 diabetes and early-onset (di-agnosed before 50 years of age) and later-onset cancer risk. RESEARCH DESIGN AND METHODS We prospectively followed 228,073 eligible participants in the Nurses’ Health Studies for up to 38 years. Hazard ratios (HRs) and 95% CI were estimated using Cox models. RESULTS We documented 18,290 type 2 diabetes, 6,520 early-onset cancer, and 36,907 later-onset cancer cases during follow-up. In fully adjusted analyses, early-onset type 2 diabetes was associated with increased risk of early-onset total cancer (HR [95% CI] 1.47 [1.06–2.04]), diabetes-related cancer (2.11 [1.38–3.23]), and obe-sity-related cancer (1.75 [1.08–2.82]), and the risk elevations were restricted to those with a BMI at 18 years of age of ‡21 kg/m2 (total cancer: 1.75 [1.20–2.56]; diabetes-related cancer: 2.43 [1.50–3.94]; and obesity-related cancer: 1.84 [1.05–3.22]). Early-onset type 2 diabetes was associated with higher risk of later-onset diabetes-related and obesity-related cancer specifically among individuals with higher BMI at 18 years of age. Later-onset type 2 diabetes was associated with a higher risk of later-onset total cancer (1.15 [1.11–1.20]), diabetes-related cancer (1.17 [1.12–1.22]), and obesity-related cancer (1.18 [1.13–1.24]). In analyses based on refined timing, the HRs attenuated substantially with aging. CONCLUSIONS Incident early-onset type 2 diabetes was associated with increased risk of early-onset total cancer and diabetes-and obesity-related cancer, especially in those with higher BMI at 18 years of age. The impact of early-onset type 2 diabetes on cancer risk may be inherently stronger than that of later-onset type 2 diabetes.
AB - OBJECTIVE We evaluated prospectively the association between incident early-onset (diag-nosed before 40 years of age) and later-onset type 2 diabetes and early-onset (di-agnosed before 50 years of age) and later-onset cancer risk. RESEARCH DESIGN AND METHODS We prospectively followed 228,073 eligible participants in the Nurses’ Health Studies for up to 38 years. Hazard ratios (HRs) and 95% CI were estimated using Cox models. RESULTS We documented 18,290 type 2 diabetes, 6,520 early-onset cancer, and 36,907 later-onset cancer cases during follow-up. In fully adjusted analyses, early-onset type 2 diabetes was associated with increased risk of early-onset total cancer (HR [95% CI] 1.47 [1.06–2.04]), diabetes-related cancer (2.11 [1.38–3.23]), and obe-sity-related cancer (1.75 [1.08–2.82]), and the risk elevations were restricted to those with a BMI at 18 years of age of ‡21 kg/m2 (total cancer: 1.75 [1.20–2.56]; diabetes-related cancer: 2.43 [1.50–3.94]; and obesity-related cancer: 1.84 [1.05–3.22]). Early-onset type 2 diabetes was associated with higher risk of later-onset diabetes-related and obesity-related cancer specifically among individuals with higher BMI at 18 years of age. Later-onset type 2 diabetes was associated with a higher risk of later-onset total cancer (1.15 [1.11–1.20]), diabetes-related cancer (1.17 [1.12–1.22]), and obesity-related cancer (1.18 [1.13–1.24]). In analyses based on refined timing, the HRs attenuated substantially with aging. CONCLUSIONS Incident early-onset type 2 diabetes was associated with increased risk of early-onset total cancer and diabetes-and obesity-related cancer, especially in those with higher BMI at 18 years of age. The impact of early-onset type 2 diabetes on cancer risk may be inherently stronger than that of later-onset type 2 diabetes.
UR - http://www.scopus.com/inward/record.url?scp=85144395982&partnerID=8YFLogxK
U2 - 10.2337/dc22-1575
DO - 10.2337/dc22-1575
M3 - Article
C2 - 36399782
AN - SCOPUS:85144395982
SN - 0149-5992
VL - 46
SP - 120
EP - 129
JO - Diabetes Care
JF - Diabetes Care
IS - 1
ER -