| Summary: | 碩士 === 中山醫學大學 === 醫學研究所 === 102 === Objective：Epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer. Possible mechanisms include hyperinsulinemia, hyperglycemia, inflammation, and anti-diabetic drugs. Hypoglycemia also causes inflammation. However, it is unknown whether this kind of inflammation will lead to cancer. We investigated the risk of all-site cancer in patients with type 2 diabetes with or without prior severe hypoglycemia.
Methods and Materials：The study population derived from the National Health Insurance Research Database released by the Taiwan National Health Research Institutes during 1999-2011, comprised 116577 patients with newly diagnosed type 2 diabetes. After excluding patients with prior cancer, we selected subjects≧18 years old and divided them into two groups according to whether they had severe hypoglycemia(total study population: 110999 patients). We compared the differences between groups in demographic data, anti-diabetic drugs, and comorbidity. We designed a 13-year retrospective cohort study consisting of severe hypoglycemic type 2 diabetic patients and matched type 2 diabetic patients without severe hypoglycemia. We investigated the relationships of severe hypoglycemia with all-site cancer and try to find independent risk factors for all-site cancer in patients with type 2 diabetes.
Results：There were 4963 patients(4.47%) with severe hypoglycemia among the total study population(110999 patients). Patients with severe hypoglycemia were older and had a higher percentage of female gender, lower monthly income, lower urbanization, cardiovascular disease, chronic lung disease, hyperlipidemia, renal disease, mental disorder, and anti-diabetic drugs prescription. However, patients without severe hypoglycemia had a higher percentage of chronic liver disease. During the 13-year retrospective cohort study(with and without sever hypoglycemia:1:2), Kaplan-Meier survival analysis of cumulative incidence of cancer showed patients with severe hypoglycemia had a higher risk of developing cancer(Log-Rank test, p<0.001). Results of Cox proportional hazard models revealed that severe hypoglycemia (HR:1.70, 95% CI:1.52-1.91, p<0.01), older age (HR:1.03 per 1 year, 95% CI:1.02-1.03, p<0.01), male gender (HR:1.41, 95% CI:1.28-1.54, p<0.01) were independent risk factors of all-site cancer. Anti-diabetic drugs would not increase the risk of cancer.
Conclusion and Suggestion：According to our study design, severe hypoglycemia is an independent risk factor of all-site cancer. Anti-diabetic drugs would not increase the risk of cancer. More attention may be needed for patients with type 2 diabetes suffering from severe hypoglycemia. The influence of severe hypoglycemia on cancer warrants further investigation.
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