Abstract 741: Incident diabetes by obesity-related cancer status and cancer treatment type
Authors: Winn Maci , Pauleck Svenja , Viskochil Richard , Richardson Stephanie , Litchman Michelle , Colman Howard , Ulrich Neli , Hu-Lieskovan Siwen , Playdon Mary , Hardikar Sheetal 
Published: April 2023

Abstract
Background: Diabetes has been associated with an increased risk of the development of multiple cancers, however, evidence for development of diabetes after cancer diagnosis is limited.
Methods: Using data on 7,702 cancer patients treated at the Huntsman Cancer Institute, a comprehensive cancer center in Utah, we examined the association of systemic cancer treatments (chemotherapy, immunotherapy, hormone therapy, and corticosteroids) and obesity-related cancer (ORC) status (presence of breast, colorectal, ovarian, endometrial, kidney, thyroid, meningioma, multiple myeloma, gallbladder, gastric cardia, esophageal adenocarcinoma, liver, or pancreatic cancer), with the development of diabetes after cancer diagnosis. Cox proportional-hazards regression models adjusting for relevant covariates [age, sex, race, body mass index at cancer diagnosis, and ORC status (in treatment-related models only)] were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Diabetes, cancer treatment type, and cancer sites were identified using ICD codes and tumor histology.
Results: 975(12.7%) cancer patients had incident diabetes (723 of which were type-2 diabetes), and the average time to diabetes diagnosis after cancer diagnosis was 4.4 years. 35.1% used chemotherapy, 11.8% used immunotherapy, 19.5% used hormone therapy, 38.8% used corticosteroids, and 40.8% had an ORC. ORC patients and patients who used corticosteroids had a statistically significant higher hazard of new-onset diabetes [HR(95% CI) 1.43(1.24-1.65), 1.29(1.13-1.47), respectively] compared to patients with a non-ORC and patients who did not use corticosteroids, respectively. Interestingly, patients who received chemotherapy or hormone therapy had a statistically significant lower hazard of new-onset diabetes [HR(95% CI) 0.69(0.60-0.79), 0.68(0.58-0.81), respectively] compared to patients who did not receive chemotherapy or hormone therapy, respectively. Analyses by cancer site and diabetes type and evaluating death as a competing risk factor are ongoing.
Conclusions: We observed statistically significant 1.43-times and 1.29-times higher hazards of incident diabetes after cancer diagnosis in ORC patients and corticosteroid users. These results suggest that certain cancers and cancer treatments may increase diabetes risk. As monitoring cancer patients for persistent hyperglycemia and diabetes is currently not a clinical standard, understanding the risk of chronic diseases, including diabetes, can inform strategies to monitor patients and decrease disease burden in this vulnerable population.
Citation Format: Maci Winn, Svenja Pauleck, Richard Viskochil, Stephanie Richardson, Michelle Litchman, Howard Colman, Neli Ulrich, Siwen Hu-Lieskovan, Mary Playdon, Sheetal Hardikar. Incident diabetes by obesity-related cancer status and cancer treatment type [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 741.