Association Between Diabetes and Site‐Specific Cancer Risk: A Population‐Based Cohort Study on the Differential Role of Metabolic Profiles

This study is aimed at investigating (i) whether diabetes is associated with each site-specific cancer and (ii) whether metabolic factors (lipids and liver enzyme) are differentially linked to different site-specific cancers by diabetes status. A retrospective cohort study was performed using electronic health records of Hong Kong. Patients who utilized public healthcare services between the year 1997 and 2021 with complete laboratory records and no cancer history were included. Patients were followed up until December 31, 2021. The associations with each site-specific cancer (colon and rectum, liver, pancreas, bladder, kidney, stomach, and lung) were assessed using Cox regression. A total of 197,906 patients were included. Patients with primarily Type 2 diabetes had a higher risk of developing liver and pancreatic cancers (aHRs for liver: 1.39, 95% CI = 1.11-1.75; pancreas: 2.04, 95% CI = 1.40-2.96) when compared to those without diabetes. Each 1 mmol/L increase in fasting glucose was associated with a 4% and 8% elevated risk of developing liver and pancreatic cancers, respectively. In general, lower lipids were linked to an increased risk of several malignancies (liver, pancreas, kidney, and stomach). In conclusion, diabetes is associated with an elevated risk of liver and pancreatic cancers. Baseline lipids and liver enzyme could be differentially linked to the risk of cancers at different organ sites by diabetes status.