Editorial
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Diabetes. Apr 15, 2012; 3(4): 60-64
Published online Apr 15, 2012. doi: 10.4239/wjd.v3.i4.60
Diabetes, insulin and cancer risk
Xi-Lin Yang, Juliana CN Chan
Xi-Lin Yang, Department of Epidemiology, Public Health College, Tianjin Medical University, Tianjin 300070, China
Xi-Lin Yang, Juliana CN Chan, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
Juliana CN Chan, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
Author contributions: Yang XL and Chan JC developed the concept and wrote the paper.
Supported by The Hong Kong Foundation for Research and Development in Diabetes, Lioa Wun Yuk Diabetes Memorial Fund, established under the auspices of the Chinese University of Hong Kong
Correspondence to: Xi-Lin Yang, Professor, Department of Epidemiology, Public Health College, Tianjin Medical University, Tianjin 300070, China. yxl@hotmail.com
Telephone: +86-22-23542659 Fax: +86-22-23542761
Received: May 20, 2011
Revised: March 3, 2012
Accepted: April 10, 2012
Published online: April 15, 2012
Abstract

There is a consensus that both type 1 and type 2 diabetes are associated with a spectrum of cancers but the underlying mechanisms are largely unknown. On the other hand, there are ongoing debates about the risk association of insulin use with cancer. We have briefly reviewed recent related research on exploration of risk factors for cancer and pharmacoepidemiological investigations into drug use in diabetes on the risk of cancer, as well as the current understanding of metabolic pathways implicated in intermediary metabolism and cellular growth. Based on the novel findings from the Hong Kong Diabetes Registry and consistent experimental evidence, we argue that use of insulin to control hyperglycemia is unlikely to contribute to increased cancer risk and that dysregulations in the AMP-activated protein kinase pathway due to reduced insulin action and insulin resistance, the insulin-like growth factor-1 (IGF-1)-cholesterol synthesis pathway and renin-angiotensin system, presumably due to reduced insulin secretion and hyperglycemia, may play causal roles in the increased risk of cancer in diabetes. Further exploration into the possible causal relationships between abnormalities of these pathways and the risk of cancer in diabetes is warranted.

Keywords: Diabetes; Insulin; Cancer; Hyperglycemia; Cholesterol synthesis pathway; Renin-angiotensin system; adenosine 5′-monophosphate -activated protein kinase pathway