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Risk associations of long-term HbA1c variability and obesity on cancer events and cancer-specific death in 15,286 patients with diabetes - A prospective cohort study
- Source :
- The Lancet Regional Health: Western Pacific, The Lancet Regional Health. Western Pacific, Vol 18, Iss, Pp 100315-(2022)
- Publication Year :
- 2022
- Publisher :
- Elsevier BV, 2022.
-
Abstract
- Background Obesity, cancer and diabetes frequently coexist. The association of glycaemic variability (GV) and obesity with cancer events had not been explored in diabetes. Methods In the prospective Hong Kong Diabetes Register cohort (1995-2019), we used cox proportional hazards models to examine the risk associations of GV with all-site cancer (primary outcome) and cause-specific death (secondary outcome). We also explored the joint association of obesity and GV with these outcomes and site-specific cancer. We expressed GV using HbA1c variability score (HVS) defined as percentage of HbA1c values varying by 0.5% compared with values in preceding visit. Findings We included 15,286 patients (type 2 diabetes: n=15,054, type 1 diabetes: n=232) with ≥10 years of diabetes and ≥3 years of observation (51.7% men, age (mean±SD): 61.04±10.73 years, HbA1c: 7.54±1.63%, body mass index [BMI]: 25.65±3.92 kg/m2, all-site cancer events: n=928, cancer death events: n=404). There were non-linear relationships between HVS and outcomes but there was linearity within the high and low HVS groups stratified by the median (IQR) value of HVS (42.31 [27.27, 56.28]). In the high HVS group, the adjusted hazard ratios (aHR) of each SD of HVS was 1.15 (95% CI: 1.04, 1.26) for all-site cancer (n=874). The respective aHRs for breast (n=77), liver (n=117) and colorectal (n=184) cancer were 1.44 (1.07, 1.94), 1.37 (1.08, 1.74), and 1.09 (0.90, 1.32). In the high GV group, the respective aHRs were 1.21 (1.06, 1.39), 1.27 (1.15, 1.40), and 1.15 (1.09, 1.22) for cancer, vascular, and noncancer nonvascular death. When stratified by obesity (BMI ≥25 kg/m2), the high HVS & obese group had the highest aHRs of 1.42 (1.16, 1.73), 2.44 (1.24, 4.82), and 2.63 (1.45, 4.74) respectively for all-site, breast, and liver cancer versus the low GV & non-obese group. The respective aHRs were 1.45 (1.07, 1.96), 1.47 (1.12, 1.93), and 1.35 (1.16, 1.57) for cancer, vascular, and noncancer nonvascular death. Interpretation Obesity and high GV were associated with increased risk of all-site, breast, liver cancer, and cancer-specific death in T2D. Funding The Chinese University of Hong Kong Diabetes Research Fund
- Subjects :
- BP, blood pressure
LDLC, low-density lipoprotein cholesterol
obesity
BMI, body mass index
Type 2 diabetes
IQR, inter‐quartile range
Prospective cohort study
diabetes
TG, triglyceride
Health Policy
Hazard ratio
MD, median
Mn, mean
EMR, electronic medical record
Obstetrics and Gynecology
LLD, lipid lowering drug
Psychiatry and Mental health
Infectious Diseases
HVS, HbA1c variability score
cancer and all cause death
HKDR, Hong Kong Diabetes Register
Public aspects of medicine
RA1-1270
Research Paper
medicine.medical_specialty
HDLC, high-density lipoprotein cholesterol
T2D, type 2 diabetes
CVD, cardiovascular disease
OGLDs, oral glucose lowering drugs
glycaemic variability
RAS, renin angiotensin system
ALT, alanine aminotransferase
Internal medicine
Diabetes mellitus
Internal Medicine
medicine
HA, Hospital Authority
Type 1 diabetes
business.industry
Public Health, Environmental and Occupational Health
Cancer
aHR, adjusted hazard ratio
medicine.disease
HR, hazard ratio
Obesity
CI, confidence interval
TC, total cholesterol
GV, glycaemic variability
SDIM, SD independent of mean
Pediatrics, Perinatology and Child Health
Geriatrics and Gerontology
SD, standard deviation
business
Body mass index
Subjects
Details
- ISSN :
- 26666065
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- The Lancet Regional Health - Western Pacific
- Accession number :
- edsair.doi.dedup.....d953cc5b7d9bfe2b9a96e9e012aa3360