Table 1Random effects estimates with 95% confidence and prediction intervals from 27 meta-analyses of type 2 diabetes mellitus and incidence of cancer or mortality
Cancer origins |
No. of cases |
Random effects (95% CI) |
Total cancer incidence |
38,010 |
1.10 (1.04–1.17) |
Total cancer mortality |
11,386 |
1.16 (1.04–1.30) |
Prostate cancer incidence |
135,970 |
0.91 (0.82–1.01) |
Thyroid cancer incidence |
1,230 |
1.16 (0.97–1.39) |
Lung cancer incidence |
207,454 |
1.03 (0.94–1.13) |
Gastric cancer incidence |
15,970 |
1.09 (0.98–1.22) |
Gastric cancer mortality |
2,447 |
1.29 (1.04–1.59) |
Colorectal cancer incidence |
61,690 |
1.27 (1.21–1.34) |
Colorectal cancer mortality |
4,394 |
1.20 (1.03–1.40) |
Hepatocellular carcinoma incidence |
33,765 |
2.31 (1.87–2.84) |
Hepatocellular carcinoma mortality |
292 |
2.43 (1.67–3.55) |
Breast cancer incidence |
30,859 |
1.20 (1.12–1.28) |
Breast cancer mortality |
4,442 |
1.24 (0.95–1.62) |
Endometrial cancer incidence |
8,174 |
1.97 (1.71–2.27) |
Endometrial cancer mortality |
103 |
1.23 (0.78–1.93) |
Ovarian cancer incidence |
7,651 |
1.17 (1.02–1.34) |
Kidney cancer incidence |
12,980 |
1.38 (1.10–1.72) |
Kidney cancer mortality |
2,646 |
1.16 (1.01–1.33) |
Esophageal cancer incidence |
3,001 |
1.30 (1.12–1.50) |
Bladder cancer incidence |
50,676 |
1.35 (1.17–1.56) |
Gallbladder cancer incidence |
1,821 |
1.52 (1.26–1.84) |
Extrahepatic cholangiocarcinoma incidence |
2,431 |
1.63 (1.29–2.05) |
Pancreatic cancer incidence |
52,445 |
1.95 (1.66–2.28) |
Intrahepatic cholangiocarcinoma incidence |
3,152 |
1.97 (1.57–2.46) |
Multiple myeloma incidence |
3,051 |
1.27 (0.98–1.64) |
Non-Hodgkin's lymphoma incidence |
12,353 |
1.27 (1.09–1.48) |
Leukemia incidence |
4,156 |
1.28 (1.05–1.57) |
Table 2Common risk factors and biological mechanisms linking diabetes and cancer
Common risk factors |
Age |
Obesity |
Smoking |
Physical inactivity |
Biological mechanisms |
Hyperglycemia |
Insulin resistance and subsequent hyperinsulinemia |
Increased bioactivity of insulin-like growth factor 1 |
Oxidative stress |
Chronic inflammation |
Adiposity |
Altered gut microbiota |
Dysregulated sex hormones |
Genetic background |
Table 3Potential risks of anti-hyperglycemic medications and cancer
Drug class |
Clinical evidence on cancer |
Reference |
Sodium glucose cotransporter 2 inhibitors |
Safe with currently available data, further studies are needed |
[4647] |
Incretin-based drugs |
Safe with currently available data, further studies are needed |
[14484950515253] |
Thiazolidinediones |
Neutral except bladder cancer risk |
[111254555657585960616263] |
Sulfonylureas |
Neutral |
[1114656667] |
Metformin |
Neutral maybe beneficial |
[6468697071] |
Insulin analogue |
Neutral |
[111233727374757677] |