針對第二型糖尿病罹患十大癌症發生比之研究

The comparison of risk between top ten cancers and type II diabetes mellitus

陳欣婷(Hsin-TingChen)

指導教授 ： 簡文山

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2015年)

https://doi.org/10.6831/TMU.2015.00004

摘要

背景：
第二型糖尿病是導致死亡率居高不下的慢性病之一，若不及早預防治療，將會導致的嚴重的合併症，包括心血管方面、慢性腎衰竭、視網膜病變、神經性病變、末梢微血管病變等。近年來糖尿病在台灣的十大死因也攀升至第五名，糖尿病不僅威脅國人健康，所消耗的健保費用，已占健保年度支出的11%，也已嚴重耗損國家醫療資源與財力。因此糖尿病的預防及照護已成為政府及國人無法忽視的問題。
此外，自1959年開始有學者發表糖尿病與癌症的相關文獻，糖尿病與癌症的關聯性開始受到大家的注意。近年來國外多篇研究指出糖尿病為導致罹患癌症的高危險因子之一，但這二種疾病的正相關的證據目前並無證據定論。以目前台灣為例，惡性腫瘤在國人的十大死因高居第一位，而患者若罹患糖尿病又合併惡性腫瘤，其癒後的情形又更加不理想。
本研究將進行探討第二型糖尿病與我國近年來十大癌症的關聯性，並研究十大癌症及病患特質、醫院特質、醫師特質之關聯性，研究結果也可以作為第二型糖尿病病患日後在健康照護上及預防及降低罹患癌症的發生方向努力。
目標：
探討十大癌症與第二型糖尿病、病患特質、醫院特質、醫師特質之關聯性。
方法：
我們使用健保資料庫內符合入選條件之對象，自2000.01.01至2003.12.31為止篩選符合糖尿病門診三次或住院一次(ICD-9-CM:250)的糖尿病患共40,424名，接著追蹤每位糖尿病患8年的醫療紀錄，探討其癌症發生情況。接著配對四倍數目在年紀、性別、發生年和糖尿病組都一樣的Control組（未發生糖尿病者），進行分析比較。
結果與結論：
本研究發現第二型糖尿病會顯著增加肝膽癌，直腸癌，胰臟癌的風險也發現第二型糖尿病與肺支氣管癌、胃癌、口腔癌、乳癌、子宮頸癌、食道癌無關聯性。另外本研究發現第二型糖尿病會下降攝護腺癌的風險其機轉與內分泌及藥物有極大關聯性。

關鍵字

第二型糖尿病 ； 十大癌症

並列摘要

Background:
Not just in Taiwan or Asian, but around the world, type two diabetes mellitus is one of the most prevalent chronic disease and also is the leading cause of death. Serious complications will occur if not prevented early, such as, cardiovascular disease, renal failure, retinopathy, neuropathy, ulceration of extremities and amputation. Diabetes is not just a threat to the welfare of the nation, but it also comprised 11% of total reimbursement from the Nation Health Insurance budget which is a liability to health resource and finance of a nation. The economy of Taiwan has improved dramatically over the last 30 years and the quality and standard of living had also improved exponentially. These improvement changed the way people lives. At same time, diabetes is now ranked 5th of the top ten leading cause in Taiwan.
A few published articles on topic of cancer and diabetes. Since then, the relationship between diabetes and cancer gradually became a popular topic. In these few years, a few articles points out that diabetes is one of the risk factor for cancer. However, there is still no prove of these two are positively associated with each other. For example, in Taiwan, malignant tumor is ranked one of the top ten leading cause of disease. At the same time, the prognosis is extremely bad when a person has both diabetes and malignant tumor.
This research will be exploring major cancer that is most prevalent among patients with diabetes. The independent variables will be gender, age, occupation, social status, urbanization rate, and the six branches of NHI. This study will explore the occurrence ratio between independent variables and malignant tumor. The research result can also provide insights and guideline for future health care system.
Purpose:
Explore the occurrence ratio between the independence variables (gender, age, occupation, social status, urbanization rate, and the six branches of NHI) and cancer.
Method:
This study uses the Taiwan NHI database. The inclusion criteria includes diabetes patients (ICD-9-CM:250)that went to outpatient three times or had being admitted from 01/01/2000 to 31/12/2003. The medical records will be gathered for the next 8 consecutive years. The last collected data was one person from 31/12/2003 who was diagnosed with diabetes, then pair a control group to quadruple the age whereas the same gender and year (Non-diabetic patient) for comparison.
Results and Conclusion:
Diabetes mellitus type two significantly increase the risk of liver and gallbladder cancer, colon cancer and pancreas cancer. On the other hand, Diabetes mellitus are not associated with trachea and lung cancer, stomach cancer, oral cancer, breast cancer, cervical cancer and esophageal cancer. Moreover, diabetes mellitus type two decrease the risk of prostate cancer and it’s mechanism of action and medication are highly associated.

並列關鍵字

Type Two Diabetes Mellitus ； Top Ten Cancer

參考文獻

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