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Associations of Glycosylated Hemoglobin, Pre-Diabetes, and Diabetes with Incident Lung Cancer: A Large Prospective Cohort Study

28 Pages Posted: 10 Jan 2023

See all articles by Junjie Hua

Junjie Hua

Sun Yat-sen University (SYSU) - Department of Epidemiology

Huan Lin

South China University of Technology - School of Medicine

Xiaojie Wang

Sun Yat-sen University (SYSU) - Department of Epidemiology

Zhengmin (Min) Qian

Saint Louis University - Department of Epidemiology and Biostatistics

Michael G. Vaughn

Saint Louis University - Department of Epidemiology and Biostatistics

Maya Tabet

University of Health Sciences and Pharmacy in St. Louis - College of Global Population Health

Chongjian Wang

Zhengzhou University - Department of Epidemiology and Biostatistics

Hualiang Lin

Sun Yat-sen University (SYSU) - Department of Epidemiology

More...

Abstract

Background: The association of pre-diabetes and diabetes with incident lung cancer is uncertain, the incident risk across the glycemic spectrum is unclear. We aimed to explore the associations of glycosylated hemoglobin (HbA1c), pre-diabetes, and diabetes with incident lung cancer in a large prospective cohort.

Methods: Leveraging a total of 283,257 cancer-free adults recruited between 2006 and 2010 in UK Biobank. We performed multivariable Cox proportional hazards models and restricted cubic spline methods to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations of HbA1c, pre-diabetes and diabetes with incident lung cancer.

Findings: During a median follow-up of 11·02 years, 2,355 incident lung cancer cases were ascertained. The incidence of lung cancer was 20% higher among diabetics (HR: 1·20, 95% CI: 1·05 to 1·38), and 37% higher among pre-diabetics (HR: 1·37, 95% CI: 1·18 to 1·60). Antidiabetic medications reduced incident lung cancer risk by 22% among diabetics. The increased risk of incident lung cancer for each standard deviation (6·67 mmol/mol) increase in HbA1c was more pronounced across HbA1c values of 32-42 mmol/mol (HR: 1·66, 95% CI: 1·46 to 1·90). The risk was also more pronounced among participants <60 years, current smokers, and those at high genetic risk of lung cancer.

Interpretation: Pre-diabetes and diabetes are associated with an increased incidence of lung cancer, antidiabetic medications can reduce the risk of incident lung cancer in diabetics. The increased risk of incident lung cancer is more pronounced across HbA1c values of 32-42 mmol/mol, which are currently considered normal values.

Funding Information: This study was supported by the National Natural Science Foundation of China (82041021).

Declaration of Interests: The authors declare that they have no competing interests.

Ethical Approval: This research has been conducted using the UK Biobank Resource (Application Number 69550).

Keywords: glycosylated hemoglobin, pre-diabetes, diabetes, lung cancer, incidence

Suggested Citation

Hua, Junjie and Lin, Huan and Wang, Xiaojie and Qian, Zhengmin (Min) and Vaughn, Michael G. and Tabet, Maya and Wang, Chongjian and Lin, Hualiang, Associations of Glycosylated Hemoglobin, Pre-Diabetes, and Diabetes with Incident Lung Cancer: A Large Prospective Cohort Study. Available at SSRN: https://ssrn.com/abstract=4320794 or http://dx.doi.org/10.2139/ssrn.4320794

Junjie Hua

Sun Yat-sen University (SYSU) - Department of Epidemiology ( email )

Huan Lin

South China University of Technology - School of Medicine ( email )

Xiaojie Wang

Sun Yat-sen University (SYSU) - Department of Epidemiology ( email )

Zhengmin (Min) Qian

Saint Louis University - Department of Epidemiology and Biostatistics ( email )

United States

Michael G. Vaughn

Saint Louis University - Department of Epidemiology and Biostatistics

Maya Tabet

University of Health Sciences and Pharmacy in St. Louis - College of Global Population Health ( email )

Chongjian Wang

Zhengzhou University - Department of Epidemiology and Biostatistics ( email )

Hualiang Lin (Contact Author)

Sun Yat-sen University (SYSU) - Department of Epidemiology ( email )

Guangzhou
China

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