Diabetes and tumor risk: a 23-year Danish national cohort study

Katja F. Skovbjerg1 *† , Julie C. Antvorskov1 *† , Lonny M. Stokholm2,3, Tine D. Bille1 , Nis Andersen 4 , Jens Andresen 4 , Toke Bek 5 , Javad Hajar 6 , Ryo Kawasaki 2,7, Caroline S. Laugesen 8 , Sören Möller 2,3, Frederik N. Pedersen2,9, Katja C. Schielke10, Anne S. Thykjær Petersen2,9,11 12, Flemming Pociot 1,13, Jakob Grauslund2,9,11 and Steffen Heegaard14,15,16

1Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark, 2Department of Clinical Research, University of Southern Denmark, Odense, Denmark, 3Open Patient

Data Explorative Network, Odense University Hospital, Odense, Denmark, 4Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark, 5Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark, 6Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark, 7 Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University Hospital, Osaka, Japan, 8Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark, 9Department of Ophthalmology, Odense University Hospital, Odense, Denmark, 10Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark, 11Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark, 12 Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark, 13Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 14Department of Pathology, Rigshospitalet, Copenhagen, Denmark, 15Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark, 16Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

Introduction: Diabetes mellitus is a recognized risk factor for cancer, yet the relationship between diabetes type and tumor risk remains unclear. This study aimed to estimate the overall tumor burden, including benign, premalignant, and malignant tumors, in individuals with type 1 and type 2 diabete

Methods: In this nationwide cohort study spanning 23 years (1999–2022), data on diabetes diagnosis, tumor development, and potential confounding variables were retrieved from multiple Danish national health registries. The cohort included more than 6.5 million individuals and 128,647 tumor events among individuals with diabetes. Crude and adjusted hazard ratios (HRs) were estimated using Cox regression.

Results: For individuals with type 1 diabetes, adjusted HRs indicated no association for overall tumor development compared to individuals without diabetes. For individuals with type 2 diabetes, adjusted HRs suggested a slightly decreased hazard for overall tumor development compared to individuals without diabetes. When excluding tumors in the skin, the association between type 1 and type 2 diabetes and overall tumor development, suggested an increased hazard compared with individuals without diabetes. Our exploratory sub-analyses were stratified by tumor topography based on Systematized Nomenclature of Medicine (SNOMED) codes. Among individuals with type 1 diabetes, eight of 28 tumor groups showed reduced hazard, including the pancreas, bile ducts, and kidney. For type 2 diabetes, one group showed reduced hazard, while 22 groups, including the heart, blood vessels, and liver, showed increased hazard. Estimates from exploratory analyses should be interpreted with caution.

Discussion: Our findings provide population-level evidence that advances our understanding of the possible complex metabolic links between diabetes and tumor development. Further exploration of SNOMED-based tumor classifications in future studies may provide valuable knowledge on pathological differences and refine future tumor and cancer surveillance strategies in individuals with diabetes

KEYWORDS

cancer, diabetes, diabetes mellitus, neoplasm, pathology, T1DM, T2DM, tumor

OPEN ACCESS

EDITED BY Weijun Peng, Central South University, China

REVIEWED BY E´ va Csajbo´ k, University of Szeged, Hungary Abdullah Al Marzan, Dhaka Medical College and Hospital, Bangladesh

*CORRESPONDENCE Katja F. Skovbjerg 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 Julie C. Antvorskov 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 †

These authors have contributed equally to this work and share first authorship

RECEIVED 14 October 2025

REVISED 02 December 2025

ACCEPTED 09 December 2025

PUBLISHED 07 January 2026

CITATION

Skovbjerg KF, Antvorskov JC, Stokholm LM, Bille TD, Andersen N, Andresen J, Bek T, Hajar J, Kawasaki R, Laugesen CS, Möller S, Pedersen FN, Schielke KC, Thykjær Petersen AS, Pociot F, Grauslund J and Heegaard S (2026) Diabetes and tumor risk: a 23-year Danish national cohort study. Front. Endocrinol. 16:1725065. doi: 10.3389/fendo.2025.1725065

COPYRIGHT

© 2026 Skovbjerg, Antvorskov, Stokholm, Bille, Andersen, Andresen, Bek, Hajar, Kawasaki, Laugesen, Möller, Pedersen, Schielke, Thykjær Petersen, Pociot, Grauslund and Heegaard. Thisis an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction, is permitted which does not comply with these terms.

近红外二区荧光导航手术在足踝外科中的应用初探

樊潇霄a,b,# , 杨杰c,# , 倪沪桅b,# , 夏启铭a , 刘孝龙a , 吴天翔b , 李霖c , Paras N. Prasad d , 刘超c, * , 林辉a,e,f, * , 钱骏a,b, *

a Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China

b Centre for Optical and Electromagnetic Research & International Research Center for Advanced Photonics, College of Optical Science and Engineering, Zhejiang University, Hangzhou 310058, China

c Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China

d Institute for Lasers, Photonics, and Biophotonics, Department of Chemistry, State University of New York, Buffalo, NY 14260-3000, USA

e Zhejiang Engineering Research Center of Cognitive Healthcare, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China

f College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China

摘要 近红外二区（NIR-II; 900~1880 nm）窗口的光学成像，是目前生物医学成像领域的热门研究课题。本研究 旨在探索 NIR-II荧光成像在足踝外科手术中的应用价值。我们开发了一套实验室自建的NIR-II荧光手 术导航系统，并将其用于足踝外科手术导航。相比于近红外一区（NIR-I）荧光图像，该系统获得的NIR-II 荧光图像，拥有更高空间频率的信息以及更高的信号背景比（SBR）。本文的研究结果表明，NIR-II成像 可为外科医生提供对比度更高、探测深度更大的图像。本研究纳入了三种临床应用场景（糖尿病足、跟骨 骨折以及下肢创伤）。利用NIR-II荧光成像技术，我们在糖尿病足出现形态学改变前就观察到了缺血区 域，精准定位了手术切口中缺血区域的边界，并全面评估了皮瓣的血供情况。NIR-II荧光成像能够帮助 外科医生精确判断手术切缘，提早发现缺血性病变，并动态追踪灌注过程。我们认为，便携且可靠的 NIR-II荧光成像设备以及更多功能性荧光探针，可在精准手术中发挥关键作用。 © 2024 THE AUTHORS. Published by Elsevier LTD on behalf of Chinese Academy of Engineering and Higher Education Press Limited Company. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

关键词  近红外二区荧光成像  足踝外科手术  吲哚菁绿  影像引导手术

A R T I C L E I N F O

Article history: Received 19 January 2024 Revised 11 April 2024 Accepted 14 April 2024 Available online 26 April 2024

分子显像在糖尿病及其并发症中的应用研究进展

李军1 刘兴党2

1北京大学深圳医院核医学科，深圳 518036；2 复旦大学附属华山医院核医学科，上海市核医学质量控制中心，上海 200040

通信作者：刘兴党，Email：该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

【摘要】 糖尿病是一种慢性代谢性疾病，全球有超过 4 亿的糖尿病患者。1 型糖尿病和 2 型糖尿病的发病机制与胰岛 β 细胞的减少和功能受损相关。糖尿病患者若长时间高血糖，则会导致心血管疾病、神经病变、糖尿病足及其他并发症。笔者就不同种类的 PET 或 SPECT 分子显像在糖尿病患者的胰岛 β 细胞的功能监测以及冠状动脉病变、心肌病、自主神经病变、大脑异常和糖尿病足的早期精准诊断中的应用研究进展进行综述。

【关键词】 糖尿病；糖尿病并发症；分子显像；正电子发射断层显像术；体层摄影术，发射型计算机，单光子

DOI：10.3760/cma.j.cn121381−202007026−00159

Li Jun1 , Liu Xingdang2

1 Department of Nuclear Medicine, Peking University Shenzhen Hospital, Shenzhen 518036, China;

2 Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai Nuclear Medicine Quality Control Center, Shanghai 200040, China

Corresponding author: Liu Xingdang, Email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

【Abstract】 Diabetes mellitus is a chronic and metabolic disease affecting more than 400 million people in the world. The pathogenesis of type 1 and type 2 diabetes mellitus is associated with the decrease or functional impairment of pancreatic β cells. With long-term hyperglycemia, diabetic patients will develop cardiovascular disease, neuropathy, diabetic foot and other complications. This paper reviews the application research progress of different types of PET and SPECT molecular imaging in the function monitoring of pancreatic β cells, and early diagnosis of diabetic complications such as coronary artery disease, cardiomyopathy, autonomic neuropathy, brain abnormalities and diabetic foot in diabetic patients.

【Key words】 Diabetes mellitus; Diabetes complications; Molecular imaging; Positron emission tomography; Tomography, emission-computed, single-photon

DOI：10.3760/cma.j.cn121381−202007026−00159

乳腺良性肿瘤热消融中西医结合诊疗指南

上海市中西医结合学会甲乳外科专业委员会

中国中西医结合学会疡科专业委员会世界中医药学会联合会乳腺病专业委员会

中国医师协会介入医师分会超声介入专业委员会

中国抗癌协会肿瘤超声治疗专业委员会 中国超声医学工程学会超声治疗及生物效应专委会

国家卫生健康委继续教育与能力建设超声医学专家委员会治疗学组 上海市医师协会超声分会

上海市抗癌协会肿瘤消融治疗专业委员会

摘要 热消融术是一种针对乳腺良性病变的新型微创治疗方法，已证实其在乳腺良性肿瘤中的疗效。本指南综合分析

高质量临床证据，结合国内著名专家的临床经验与意见，经多次专家研讨达成共识。主要阐述乳腺良性肿瘤的热消融治

疗准则与操作规范，包括适应证、禁忌证、术前评估、麻醉方式、治疗类型及并发症处理等。同时，指南还强调了中医中药

在热消融诊治过程中的重要作用，提出了“中医五位一体”的综合治疗方案。本指南可为从事乳腺良性肿瘤治疗的医师

提供了重要的参考依据。

关键词 乳腺良性肿瘤; 热消融治疗; 中西医结合; 诊疗指南; 中医五位一体

Diagnosis and Treatment Guidelines for Benign Breast Tumors by Thermal Ablation with Integrated Traditional Chinese and Western Medicine Professional Committee of Thyroid and Breast Surgery，Shanghai Association of Chinese Integrative Medicine; Professional Committee of Ulcerology，Chinese Association of Integrative Medicine; Specialty Committee of Mammary Disease，World Federation of Chinese Medicine Societies; Committee of Interventional Ultrasound，Interventional Physician Branch，Chinese Medical Doctor Association; Tumor Ultrasound Therapy Committee，China Anti-Cancer Association; Special Committee of Ultrasound Therapy and Biological Effects，Chinese Association of Ultrasound in Medicine and Engineering; Treatment Group，Ultrasound Medical Expert Committee， National Health Commission Capacity Building and Continuing Education Center; Ultrasound Branch，Shanghai Medical Doctor Association; Tumor Ablation Therapy Committee，Shanghai Anti-Cancer Association

Abstract

Thermal ablation is a novel minimally invasive treatment for benign breast lesions，with confirmed efficacy in benign breast tumors． Based on a comprehensive analysis of high-quality clinical evidence，this guideline combines the clinical experience and opinions of renowned national experts，where consensus has been reached through multiple expert discussions． This guideline primarily outlines the treatment criteria and technical specifications of thermal ablation for benign breast tumors and related diseases，including indications，contraindications，preoperative assessment，anesthesia methods，treatment types，and complication management． Additionally，the guideline emphasizes the importance of traditional Chinese medicine( TCM) in thermal ablation，putting forward the comprehensive treatment plan of“TCM five-in-one”． This guideline provides an important reference for physicians engaged in benign breast tumor treatment．

Keywords

Benign breast tumor; Thermal ablation treatment; Integrated traditional Chinese and Western medicine; Diagnosis and treatment guideline; TCM five-in-one

中图分类号: Ｒ273

文献标识码: A

doi: 10． 3969 /j． issn． 1673 － 7202． 2025． 22． 002

Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults

Taynara Formagini1,2 *, Joanna Veazey Brooks2,3,4 , Andrew Roberts2,5 , Kai McKeever Bullard6 , Yan Zhang6 , Ryan Saelee6 and Matthew James O'Brien7

1 Department of Family Medicine, University of California San Diego, San Diego, CA, United States,

2 Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States, 3University of Kansas Cancer Center, Kansas City, KS, United States, 4Division of Palliative Medicine, University of Kansas School of Medicine, Kansas City, KS, United States, 5Aetion Inc., New York, NY, United States, 6Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States, 7 Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Introduction: Racial and ethnic minority groups and individuals with limited educational attainment experience a disproportionate burden of diabetes. Prediabetes represents a high-risk state for developing type 2 diabetes, but most adults with prediabetes are unaware of having the condition. Uncovering whether racial, ethnic, or educational disparities also occur in the prediabetes stage could help inform strategies to support health equity in preventing type 2 diabetes and its complications. We examined the prevalence of prediabetes and prediabetes awareness, with corresponding prevalence ratios according to race, ethnicity, and educational attainment.

Methods: This study was a pooled cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to March 2020. The final sample comprised 10,262 U.S. adults who self-reported being Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Those with prediabetes were classified as “aware” or “unaware” based on survey responses. We calculated prevalence ratios (PR) to assess the relationship between race, ethnicity, and educational attainment with prediabetes and prediabetes awareness, controlling for sociodemographic, health and healthcare-related, and clinical characteristics.

Results: In fully adjusted logistic regression models, Asian, Black, and Hispanic adults had a statistically significant higher risk of prediabetes than White adults (PR:1.26 [1.18,1.35], PR:1.17 [1.08,1.25], and PR:1.10 [1.02,1.19], respectively). Adults completing less than high school and high school had a significantly higher risk of prediabetes compared to those with a college degree (PR:1.14 [1.02,1.26] and PR:1.12 [1.01,1.23], respectively). We also found that Black and Hispanic adults had higher rates of prediabetes awareness in the fully adjusted model than White adults (PR:1.27 [1.07,1.50] and PR:1.33 [1.02,1.72], respectively). The rates of prediabetes awareness were consistently lower among those with less than a high school education relative to individuals who completed college (fully-adjusted model PR:0.66 [0.47,0.92]).

Discussion: Disparities in prediabetes among racial and ethnic minority groups and adults with low educational attainment suggest challenges and opportunities for promoting health equity in high-risk groups and expanding awareness of prediabetes in the United States.

KEYWORDS

prediabetes, prediabetes awareness, diabetes-related disparities, race and ethnicity, educational attainment

The frequency of polycystic ovary syndrome in women with prediabetes compared with normoglycemic women

Cem Sulu1 , Ipek Pervaz 2 , Turgut Gurer 3 , Dogan Yildiz 2 , Arzu Tas 3 , Ahmet Numan Demir 1 , Serdar Sahin1 , Hande Mefkure Ozkaya1 , Dildar Konukoglu 4 , Abdullah Tuten5 , Taner Damci 1 , Fahrettin Kelestimur 6 and Mustafa Sait Gonen 1*

1 Division of Endocrinology-Metabolism and Diabetes - Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

2Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

3Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

4Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,

5 Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Türkiye,

6Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Faculty of Medicine, Yeditepe University, Istanbul, Türkiye

Objective: To determine rate of polycystic ovary syndrome (PCOS) and its related features in women with prediabetes.

Methods: Of 3465 consecutive women applied between 2021 and 2023, 3218   women with diabetes mellitus or conditions affecting gonadal functions were excluded through digital screening and tele-interviews. Remaining 247 women underwent clinical assessments, excluding another 49 due to other endocrine diseases. The diagnosis of PCOS and prediabetes were based on Rotterdam and American Diabetes Association criteria, respectively.

Results: 100 women had prediabetes and 98 women had normoglycemia. The frequency of PCOS were 17% and 19.4% in prediabetes and control groups, respectively (p=0.715). The frequency of PCOS was 24% (6/25) in women with impaired glucose tolerance (IGT) only, 22.2% (2/9) in women with impaired fasting glucose only, and 15.5% (9/58) in women who met the HbA1C criterion only. Prediabetes group had higher insulin-like growth factor-1 (IGF–1) levels and lower anti-Müllerian hormone (AMH) levels (p<0.05). Insulin was correlated with testosterone, antral follicle count, and ovarian volume only in prediabetes group (p<0.05). Mediation models showed that insulin increased testosterone both directly and indirectly through increasing IGF-1 (b=0.4, p=0.0006).

Conclusion: While the rate of PCOS was not increased in overall prediabetes group, a trend for an increased risk in IGT subgroup only was noteworthy. Positive correlation of insulin with testosterone, antral follicle count, and ovarian volume being only found in prediabetes group suggested that prediabetes might render ovaries susceptible to the PCOS-like changes. The lower AMH in prediabetes implied the toxic effects of even mild hyperglycemia on ovaries.

KEYWORDS

hyperandrogenism, impaired fasting glucose, impaired glucose tolerance, insulin resistance, polycystic ovary syndrome, prediabetes