Diabetes significantly increases the risk of cancer, particularly in people aged 40-54 years, new research shows. The analysis of data from more than three million patients warns that the risk of cancer starts to rise shortly before the formal diagnosis of diabetes and peaks in the year after.

The risk of pancreatic cancer is the highest, increasing more than twofold (129.4%) in people with diabetes than in the population without the disease, according to new research by Semmelweis University. They also found that the risk of developing liver cancer is 83% higher in people with diabetes.

The researchers analysed data from 3,681,774 individuals in the Hungarian National Health Insurance Fund database between 2010 and 2021, of whom 86,537 had diabetes. The age group analysed was between 40 and 89 years old.

During the ten-year follow-up period, 8.6% of people in the control group and 10.1% of people with diabetes were diagnosed with cancer.

In addition to pancreatic and liver cancer, the researchers also looked at the risk of four other types of tumours.

We found that people with diabetes (Type 1 and Type 2) had a higher risk of developing all six cancer types we looked into,

said Dr Heléna Safadi, assistant lecturer at the Health Service Management Training Centre of Semmelweis University and lead author of the study published in the journal Diabetes Research and Clinical Practice.

Previous research has mostly shown no increased risk of prostate cancer in people with diabetes. Therefore, further investigations are needed to confirm the new results of the Semmelweis study.

Patients with diabetes had a 44.2% higher risk of kidney cancer and a 30% higher risk of colorectal cancer compared to the population without the disease. The risk of developing prostate cancer was 17.1% higher in people with diabetes, while the risk of breast cancer was 13.7% higher.

The difference in cancer incidence between people with diabetes and controls was most significant in the younger age group: 5.4% of those with the disease aged 40-54 were diagnosed with cancer during the ten years, compared with 4.4% of controls. In contrast, in the 70-89 age group, the difference between diabetics and controls was only 0.3 percentage points (12.7% vs. 12.4%).

The researchers also observed that the time between the diagnosis of diabetes and the development of tumours was very short and that the diseases often occurred simultaneously.

“The risk of developing tumours was much higher within a year before the diagnosis of diabetes, and this peaked in the next year or two. After that, the upward trend slowed, and the odds of developing cancer in the group with diabetes and the healthy group began to converge,” explained Dr Éva Belicza, associate professor at the Health Service Management Training Centre at Semmelweis University and senior author of the study.

There are several explanations for this phenomenon. One is that elevated insulin levels may play a role in the development of tumours.

“Hyperinsulinemia, or insulin resistance, is a pre-diabetic condition where sugar levels are still normal, but the body already needs more insulin to pump sugar into the cells. This elevated use of insulin could be one of the reasons for the increased risk of cancer,” added Dr. Safadi.

The researchers urge for a rethink of screening guidelines.

“It would be important to start regular screening for diabetes or insulin resistance from as early as the age of late 30s-early 40s. As the difference in cancer risk between people with diabetes and the rest of the population is most significant in people in their 40s, it may also be important to screen them for the types of cancers examined in our study,” said Dr. Judit Lám, associate professor at the Health Service Management Training Centre at Semmelweis University and co-author of the study.

According to the International Diabetes Federation, nearly 537 million adults suffered from diabetes worldwide in 2021, and the disease led to 6.7 million deaths. The World Health Organisation states that diabetes is a leading cause of blindness, kidney failure, cardiac arrest, stroke, and lower limb amputation. Diet, exercise, medication and regular screening and treatment can prevent or delay the consequences of diabetes.

Photo: Health Service Management Training Centre – Semmelweis University; Cover (illustration): duskbabe – Envato Elements