Friday, May 3, 2013

Diabetes medications and cancer is complex and the lack of confirmed data leads to uncertainties.

The relationship between diabetes , diabetes medications and cancer is  complex and the lack of confirmed data leads to uncertainties. I have attached links to 2 previous post and timely comments that you may want to review before reading todays post.
The comments reflect the concerns each of us may have as we take our diabetes medications each day.

 Diabetes, Januvia and Cancer
 Diabetes and Pancreatic Cancer . No simple answer... 



 Certainties:

  Good

  metformin ( glucophage) reduces the risk of Cancer

   Not so good
   - Type 2 diabetes increases cancer risk. Diabetes seems to be linked to a variety of cancers including
      breast, hepatic , colon and pancreatic
    - Pioglitizone  ACTOS) increases the risk of bladder cancer
    - obesity increases cancer risk
    - smoking increases cancer risk
    - just being alive increases cancer risk
    - family history

   Uncertainties , My opinion .
     - Most of the studies have come from the volunteer reporting of adverse events to the FDA and
       similar organizations and most physicians are not reliable reporters of this type of information. 
       The other study listed below raises the question. Did the slow development of pancreatic cancer
       and  silent pancreatic damage over 10 years cause the diabetes ?

           "On the other hand, some studies demonstrated that because of underreporting , only 5%–10%
           of serious adverse reactions can be detected by spontaneous reporting systems. Whether 
           similar underreporting exists with respect to incretin-based therapies is unclear.
           Analysis of spontaneous reports does not allow adjustment for known  risk factors for 
           pancreatic cancer such as obesity, smoking, family history, or chronic pancreatitis, even if this 
            information is available."

           "Might GLP-1–based therapies induce or promote pancreatic cancer? 
          Recent studies suggested that the time  between tumor induction, tumor development, and
          metastasis/clinical diagnosis is >10 years. The German cases were individually assessed and
          the exposure time to exenatide was consistently found to be short (2–33  months). 
          Thus, given that exenatide and liraglutide have been on the market for <10 years, there is 
          considerable  doubt that exenatide induces tumor development. If the suspected 
          relationship exists, exenatide is likely to  promote tumor progression rather than initiation, 
          which corresponds with data showing that  exenatide promotes  pancreatic ductal 
          hyperplasia. 
                            "GLP-1–Based Therapies: The Dilemma of Uncertainty  
                              Gastroenterology   Volume 141, Issue 1 , Pages 20-23, July 2011
                              Joachim Spranger   Ursula Gundert–Remy, Thomas Stammschulte
                             Department of Endocrinology, Diabetes and Nutrition, Charité-  Universitätsmedizin Berlin and Drug Commission of the German Medic                                      
                              al Association, Berlin, Germany 
       
    -  "Diabetes or impaired glucose tolerance is present in 2/3rds. of pancreatic cancer patients "
           New onset diabetes in people over age 50 have a higher risk of pancreatic cancer.
                                Minerva Gastroenterol Dietol. 2012 Dec;58(4):331-45.
                                Diabetes and pancreatic cancer.
                                Muniraj T, Chari 
                                Yale University School of Medicine, New Haven, CT, USA.


I have attached a copy and paste link to an American Diabetes Association article reviewing their views on this topic.

http://www.diabetes.org/for-media/2010/experts-explore-emerging-evidence-linking-diabetes-and-cancer.html

Have fun  , Be Smart and talk to your doctor before stopping your diabetes medications
David Calder, MD


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2 comments:

  1. I agree to the fact that "most physicians are not reliable reporters of this type of information", I am not sure why but we experience the same scenario during our collection of diabetes leads.

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  2. It is very much true that smoking increase cancer risk so to reduce cancer it is important to quit smoking. In the UK people using electronic cigarettes as a smoking and it is very surprising fact that many health risks are decreasing after that. Electronic cigarettes are safe compared to tobacco cigarettes. It does not produce smoke not containing tobacco so you can easily use in every place. These are rechargeable device you can charge it whenever it gets low. For more information check out here-http://blog.best4ecigs.com/2013/07/what-are-main-differences-in-smoking.html

    ReplyDelete

Your comments and questions are appreciated. David Calder,MD