Type 2 diabetes, socioeconomic status and risk of cancer in Scotland 2001–2007

Aims/hypothesis

The objective of this study was to use Scottish national data to assess the influence of type 2 diabetes on the risk of cancer at 16 different sites, while specifically investigating the role of confounding by socioeconomic status in the diabetes–cancer relationship.

Methods

All people in Scotland aged 55–79 years diagnosed with any of the cancers of interest during the period 2001–2007 were identified and classified by the presence/absence of co-morbid type 2 diabetes. The influence of diabetes on cancer risk for each site was assessed via Poisson regression, initially with adjustment for age only, then adjusted for both age and socioeconomic status.

Results

There were 4,285 incident cancers in people with type 2 diabetes. RR for any cancers (adjusted for age only) was 1.11 (95% CI 1.05, 1.17) for men and 1.33 (1.28, 1.40) for women. Corresponding values after additional adjustment for socioeconomic status were 1.10 (1.04, 1.15) and 1.31 (1.25, 1.38), respectively. RRs for individual cancer sites varied markedly.

Conclusions/interpretation

Socioeconomic status was found to have little influence on the association between type 2 diabetes and cancer.     

Predicted impact of extending the screening interval for diabetic retinopathy: the Scottish Diabetic Retinopathy Screening programme

Aims/hypothesis

The aim of our study was to identify subgroups of patients attending the Scottish Diabetic Retinopathy Screening (DRS) programme who might safely move from annual to two yearly retinopathy screening.

Methods

This was a retrospective cohort study of screening data from the DRS programme collected between 2005 and 2011 for people aged ≥12 years with type 1 or type 2 diabetes in Scotland. We used hidden Markov models to calculate the probabilities of transitions to referable diabetic retinopathy (referable background or proliferative retinopathy) or referable maculopathy.

Results

The study included 155,114 individuals with no referable diabetic retinopathy or maculopathy at their first DRS examination and with one or more further DRS examinations. There were 11,275 incident cases of referable diabetic eye disease (9,204 referable maculopathy, 2,071 referable background or proliferative retinopathy). The observed transitions to referable background or proliferative retinopathy were lower for people with no visible retinopathy vs mild background retinopathy at their prior examination (respectively, 1.2% vs 8.1% for type 1 diabetes and 0.6% vs 5.1% for type 2 diabetes). The lowest probability for transitioning to referable background or proliferative retinopathy was among people with two consecutive screens showing no visible retinopathy, where the probability was <0.3% for type 1 and <0.2% for type 2 diabetes at 2 years.

Conclusions/interpretation

Transition rates to referable diabetic eye disease were lowest among people with type 2 diabetes and two consecutive screens showing no visible retinopathy. If such people had been offered two yearly screening the DRS service would have needed to screen 40% fewer people in 2009.     

美国胃肠病学会对炎症性肠病患者结直肠癌的诊断和处理观点

<正> 本文就临床医师面对具有结直肠癌(CRC)风险的炎症性肠病(IBD)患者时所关心的一系列问题作一探讨。针对每个问题进行了广泛的文献检索、相关临床证据回顾,并评价相关数据的循证力度。结论的产生基于可获得的最佳证据,证据不足时则来自专家观点或其他指南。推荐强度参照美国预防服务工作组(USPSTF)的分级系统。搜寻Medline数据库,主题词为异型增生、结直肠癌、监