Oncological pathology in type 2 diabetes patients and its effects on the effectiveness of the treatment of diabetes

Z. G. Krushinska, T. Yu. Yuzvenko

DOI: http://dx.doi.org/10.12775/JEHS.2019.09.11.032

Abstract


Actuality of theme. The recognition of diabetes and cancer by global non-communicable epidemics necessitates the need for research into the mechanisms behind the combination of diabetes and cancer, and the factors that lead to it.

The goal of the work. To study the structure and frequency of oncological pathology in patients with type 2 diabetes and its effect on the effectiveness of diabetes treatment.

Materials and methods. The study involved 2264 patients with type 2 diabetes (1186 men, 1078 women) who were treated at theUkrainianResearchCenter for Endocrine Surgery, Endocrine Transplantation and Tissue of the Ministry of Health ofUkraine. The frequency and structure of oncological pathology in patients with type 2 diabetes, depending on the region of Ukraine, including the territories of military conflict, the place of residence of patients (countryside, city), duration of type 2 diabetes, BMI, HbA1c, medication tactics, macrovascular complications of diabetes (myocardial infarction (MI), stroke, diabetic foot syndrome (UDF). Medical and social factors were studied using a comparative analysis of the data obtained. Statistical processing of the obtained data was carried out using the program Statistika 10.0 (StatSoft).

Results and discussion. The incidence of cancer in patients with MI and stroke (7.12% and 10.1%, respectively) is higher than in patients without such complications (6.46% and 6.05%, respectively) with the opposite situation in patients with UDF - 2.3 times less than in patients without UDF (3.4% vs. 7.7%), and this indicator in patients with MI, stroke and without macrovascular complications is 1.8-3.0 times higher than in patients with UDF. The incidence of cancer is significantly higher when combined with 2 macrovascular complications. Almost 90% of cancers were diagnosed with type 2 diabetes.

The share of women with oncological pathology is twice as high as in men with a greater difference in patients from the Western region (13.8 times), BMI over 40 kg/m2 (5.5 times), HbA1c 9.1-10.0% (4.6 times), duration of diabetes 11-15 years and more than 20 years (3.4 times and 3.9 times, respectively), Central region and duration of diabetes 16-20 years (3.3 times). The incidence of cancer in men (4.47% among all men) is higher in patients with MI and stroke, Eastern and Southern regions, duration of diabetes 6-10 years, BMI 30-34.9 kg/m2 and 35-39.9 kg/m2, HbA1c up to 6.0% and 8.1-9.0% and in patients with insulin therapy, but less in patients with UDF, Western and Central regions, BMI 18.5-24.9 kg/m2, 25-29.9 kg/m2 and over 40 kg/m2, newly diagnosed type 2 diabetes, duration of type 2 diabetes 11-15 years, 16-20 years and more than 20 years, HbA1c 8.1-9,% and more than 10.0% and in patients on combination therapy. The incidence of oncologic pathology in women (8.81% among all women) is higher in patients with MI, stroke, Western and Southern region, duration of diabetes mellitus type 11-15 years, BMI 35-39.9 kg/m2 and over 40 kg/m2, HbA1c up to 6.0% and 8.1-9.0%, but less in patients with UDF, Eastern region and territories of military conflict, duration of type 2 diabetes over 20 years, rural area, BMI 18.5-24.9 kg/m2, HbA1c 8.1-9,% and more than 10.0% in patients with insulin therapy.

The leading place in the structure of oncologic pathology is occupied by thyroid cancer with a higher rate in patients with stroke, without macrovascular complications and lower rates in patients with MI and UDF and genital cancer with the opposite situation in the proportion of patients with such pathology. The incidence of breast and kidney cancer in patients with UDF is several times higher than in patients with MI, stroke and without macrovascular complications. In the structure of oncological pathology in men with MI, the first place occupy the prostate cancer and the cancer of the thyroid gland (36.36% and 18.18%), with stroke - thyroid cancer (33.33%), prostate, testes, colon and kidney (16.67% each), with UDF - thyroid cancer, kidney cancer and lymphocytic leukemia (20.0% each), and without macrovascular complications - thyroid cancer and gastric cancer (62.5% and 12.5% respectively). Proportion of prostate, colon and kidney cancer in men with macrovascular complications is several times higher than in patients without such complications. In the structure of oncological pathology in women with MI and stroke, the first place is occupied by thyroid cancer (50.0% and 57.14% respectively) and cervical cancer (40.0% and 23.08% respectively), with UDF - breast and thyroid cancer (40.0% and 20.0% respectively), and without macrovascular complications - thyroid cancer and adrenal cancer (47.54% and 11.48% respectively). Thyroid cancer share in women with MI, stroke and without macrovascular complications more than twice as high as in patients with UDF with the opposite situation with breast cancer, whose proportion in the structure of cancer is more than four times higher in patients with UDF.

No case of gastric cancer in patients with MI, stroke and VTS with the same rate in patients without macrovascular complications (3,57-4,03%). No cases of adrenal cancer in patients with MI, single cases in patients with stroke and VTS as opposed to high and equal rates in patients without macrovascular complications (9,29-10,77%). No cases of lung and stomach cancers in men and women with macrovascular complications; for adrenal cancer in men with macrovascular complications and in women with MI; kidney cancer in women with macrovascular complications; colorectal cancer in women of all categories of patients.

Conclusions. The incidence of oncologic pathology in patients with type 2 diabetes has significant differences depending on the patient's sex, territory and place of residence, duration of diabetes, BMI, HbA1c, macrovascular complications and medication tactics. The incidence of cancer in patients with type 2 diabetes is not significantly influenced by HbA1c levels in patients of both sexes, BMI in men, and women's residence, but the patient's area of residence and macrovascular complications of type 2 diabetes in patients of both sexes, the duration of diabetes in men and BMI in women have a significant impact, moderate impact - male habitat and duration of type 2 diabetes in women.


Keywords


type 2 diabetes; cancer; cancer; efficacy; medical factors; social factors

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