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    • br Conflict of Interest br Author Contributions

    2018-10-23


    Conflict of Interest
    Author Contributions
    Acknowledgements
    Introduction Previous studies suggest that impaired glucose regulation may be associated with cancer incidence or cancer-related death. This association was found among patients with diabetes mellitus (Hirakawa et al., 2012; Jee et al., 2005; Levine et al., 1990; Saydah et al., 2003), pre-diabetic levels of impaired fasting glycemia (Hirakawa et al., 2012; Jee et al., 2005; Huang et al., 2014; Rapp et al., 2006), or impaired glucose tolerance (Hirakawa et al., 2012; Huang et al., 2014; Zhou et al., 2010). In those studies, impaired glucose regulation was detected with the oral glucose-tolerance test (OGTT), where 2-h post-load glucose levels were measured after a standardized dose of oral glucose (Hirakawa et al., 2012; Zhou et al., 2010). Impaired glucose tolerance can also be detected with the intravenous glucose-tolerance test (IVGTT), where an artificial increase in plasma glucose induces insulin secretion from pancreatic β cells. The characteristic biphasic insulin secretion response is a rapid, transient first phase, which lasts a few minutes, followed by a more sustained second phase (Seino et al., 2015). In contrast, the insulin secretion response of β ALW-II-41-27 during an OGTT is more complex; it can produce variable results, due to the combined influences of plasma glucose, hormones, neurotransmitters, and nutrients. In the present study, we investigated the relationship between glucose tolerance and cancer risk in a 40-year follow-up study of initially healthy middle-aged men. We implemented the IVGTT, with plasma glucose measurements every 10min for 1h. We aimed to explore the association between cancer risk and the responses to an IVGTT, including the first phase (plasma glucose at 10min) and second phase (plasma glucose at 10–60min) of the glucose induced insulin response.
    Materials and Methods
    Results The baseline characteristics of the included study population are presented in Table 1. Overall, the mean age at inclusion was 49.8years, and the median glucose value at 10min was 11.66mmol/L. The mean glucose levels at 10min were 10.65 and 12.74mmol/L among men below and above the median, respectively. Men with high 10-min glucose levels had higher glucose levels during the entire IVGTT than men with low 10-min glucose levels, despite considerable variation between individuals (Fig. 1). The median KG was 1.86 (interquartile range 1.42–2.50). There were no significant differences in baseline characteristics (except for height) and cancer incidence between men included (blood sampling every 10min) and not included (blood sampling every 15min) in the analyses (Appendix Table 1A and 1B). During the 40-year follow-up (median 26.3years, range 0.1–40.3years), 376 men were diagnosed with cancer. A higher cancer incidence was observed among men with low than those with high 10-min glucose levels (Fig. 2, Table 2). There was a significant inverse association between 10-min glucose levels and all-site cancer (IRR: 1.5, 95% CI: 1.2–1.9). This association remained significant, when we divided the follow-up times into four sequential decades. The corresponding IRRs [95% CIs] were as follows: first decade: 3.0 [1.4–6.4]; second decade: 1.6 [1.1–2.4]; third decade: 1.6 [1.1–2.2]; and fourth decade: 1.5 [1.01–2.2]. Additionally, the IRRs were significantly higher in digestive organs (i.e., liver, gallbladder and bile ducts, and pancreas; IRR: 3.5, 95% CI: 1.3–9.4) and colon (IRR: 1.9, 95% CI: 1.1–3.5). We observed no association between fasting glucose and the incidence of cancer. Moreover, at the sequential follow-up times, we found no association between glucose levels at 20, 30, 40, 50, and 60min after the IVGTT and the incidence of cancer (data not shown). Furthermore, the KG was not associated with the incidence of all-site cancer. The Cox regression analysis showed that the risk of all-site cancer in men with low 10-min glucose levels was significantly higher than in those with high 10-min glucose levels (HR: 1.6, 95% CI: 1.3–2.0; Table 3). This difference remained significant after adjusting for age at inclusion, fasting glucose level, smoking, physical fitness, body weight, and height (HR: 1.6, 95% CI: 1.3–2.1). Diabetes mellitus was diagnosed in 91 men during follow-up; however, we detected no significant association with cancer risk (Model III, HR: 1.3, 95% CI: 0.8–1.9).