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Changes in physical activity and diabetes risk after cancer diagnosis: a nationwide cohort study

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Abstract

Purpose

Physical activity has the potential to reduce the risk of diabetes after cancer diagnosis. However, current evidence supporting its effects is limited. This study aims to examine the associations between changes in physical activity and subsequent risk of diabetes among cancer survivors.

Methods

A total of 264,250 cancer survivors (mean age 56.7 (12.5) years, 44.2% males) without a prior history of diabetes were assessed for adherence to physical activity both before and after their diagnosis. The primary outcome was incident diabetes. The Fine-Gray proportional sub-distribution hazards model was used to calculate sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for diabetes risk, considering death as a competing risk.

Results

Over a follow-up of 1,065,802 person-years, maintaining regular physical activity from pre-diagnosis was associated with a 10% reduced risk of diabetes after cancer diagnosis (sHR 0.90, 95% CI 0.85–0.96), considering traditional diabetes risk factors, sociodemographics, and primary cancer sites. Cancer survivors who became active and inactive after their cancer diagnosis exhibited a marginally decreased risk of diabetes (sHR 0.98, 95% CI 0.93–1.03; sHR 0.97, 95% CI 0.92–1.03). The strength and direction of the association varied depending on the primary site of cancer.

Conclusions

Regular physical activity starting before a cancer diagnosis is associated with a lower risk of diabetes following the diagnosis, independent of established diabetes risk factors.

Implications for Cancer Survivors

The study underscores the importance of engaging in sufficient physical activity to mitigate the risk of diabetes in cancer survivors.

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Data availability

The data will be made available upon request and approval of a proposal by the National Health Insurance Service Database.

Abbreviations

sHR:

Sub-distribution hazard ratio

CI:

Confidence interval

NHIS:

National Health Insurance Service

SD:

Standard deviation

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Author information

Authors and Affiliations

  1. Department of Family Medicine/Obesity and Metabolic Health Center, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea

    Wonyoung Jung

  2. Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Wonyoung Jung

  3. Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    In Young Cho & Dong Wook Shin

  4. Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jinhyung Jung

  5. Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Mi Hee Cho

  6. Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Hye Yeon Koo

  7. Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Yong-Moon Mark Park & Jong-Ha Baek

  8. Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Yong-Moon Mark Park

  9. Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea

    Jong-Ha Baek

  10. Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea

    Kyungdo Han

  11. Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea

    Dong Wook Shin

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Contributions

Wonyoung Jung: Conceptualization, Investigation, Methodology, Writing- original draft, Writing – review &; editing; In Young Cho: Investigation, Methodology, Writing – review &; editing; Jinhyung Jung: Data curation, Formal analysis, Methodology, Software; Mi Hee Cho: Writing – review &; editing; Hye Yeon Koo: Writing – review &; editing; Yong-Moon Mark Park: Methodology, Writing – review &; editing; Jong-Ha Baek: Writing – review &; editing; Kyungdo Han: Data curation, Formal analysis, Methodology, Visualization, Software; Dong Wook Shin: Conceptualization, Investigation, Project administration, Methodology, Supervision, Validation, Writing – review &; editing.

Corresponding authors

Correspondence to Kyungdo Han or Dong Wook Shin.

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Wonyoung Jung and In Young Cho are co-first authors.

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Jung, W., Cho, I.Y., Jung, J. et al. Changes in physical activity and diabetes risk after cancer diagnosis: a nationwide cohort study. J Cancer Surviv (2024). https://doi.org/10.1007/s11764-024-01606-2

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