Highlights
- •Both prediabetes and diabetes were associated with an increased BTC risk.
- •A longer diabetes duration was associated with a further increase in BTC risk.
- •Prediabetes, diabetes, and diabetes duration may be risk factors for BTC.
Abstract
Background & aims
Population-based evidence of the association between diabetes and biliary tract cancer
(BTC) risk is lacking. We aimed to evaluate the association of prediabetes, diabetes,
and diabetes duration with subsequent risk of BTC, including cholangiocarcinoma (CCA)
and gallbladder cancer (GBC), in the Korean general population.
Methods
This nationwide cohort study included 9,697,773 adults aged ≥20 years without cancer
who underwent national health screening between January and December 2009. Subjects'
glycemic status was categorized as normoglycemic, impaired fasting glucose (IFG),
newly-diagnosed diabetes, diabetes duration <5 years, and diabetes duration ≥5 years.
Incident BTC was identified using claims data. Follow-up continued until December
2017. Cox proportional hazard models were used to estimate multivariable-adjusted
hazard ratios and 95% CIs of BTC.
Results
During a median follow-up of 7.2 years, 13,022 patients were newly diagnosed with
BTC. Compared with the normoglycemic group, the IFG, newly-diagnosed diabetes, diabetes
duration <5 years, and diabetes duration ≥5 years groups showed the following adjusted
hazard ratios (95% CIs) for BTC: 1.08 (1.04–1.12), 1.31 (1.22–1.41), 1.35 (1.27–1.43),
and 1.47 (1.39–1.55), respectively. BTC risk significantly increased with deteriorating
glycemic status (P for trend <0.001). These results were consistent with those of CCA and GBC analyses.
Conclusions
Both IFG and diabetes were independently associated with an increased risk of BTC,
including CCA and GBC. A longer diabetes duration was associated with a further increase
in BTC risk. Diabetes and even IFG may be modifiable risk factors for BTC.
Abbreviations:
BMI (body mass index), BTC (biliary tract cancer), CCA (cholangiocarcinoma), CI (confidence interval), GBC (gallbladder cancer), HR (hazard ratio), ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification), IFG (impaired fasting glucose), NHIS (National Health Insurance Service), NRF (National Research Foundation), SI (synergy index.)Keywords
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Article info
Publication history
Published online: August 05, 2021
Accepted:
August 3,
2021
Received:
March 25,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc.
