A recent paper1 in the British Medical Journal on Type 2 diabetes (T2DM) and cancer, reminds us of the significant relationship between colorectal cancer and metabolic abnormalities. Indeed, an accompanying editorial by Satija et al2 concludes that “because of the rising incidences of both diseases worldwide action is needed for both clinical and public health communities to follow appropriate cancer screening guidelines among people with diabetes with a greater emphasis on lifestyle modifications”. But no one says it is important that diabetes screening guidelines should be a followed among people with raised risk for colorectal cancer.

Our recent paper3 reported that amongst 329 overweight people diagnosed with a colorectal adenoma, 14% had a pre-existing diagnosis of T2DM, 7.6% were classified as having potentially undiagnosed T2DM and 125 (50%) were at high risk of developing the disease. The participants were taking in part in a lifestyle trial of weight loss and at 12 months follow up diabetes risk category diminished in 20% of the intervention group and 11% of the control.

It seems to make sense that if overweight people with an increased risk of diabetes are being seen in a health service setting, that a diabetes assessment might usefully be undertaken, and support for lifestyle change offered. Lifestyle interventions can have clinically relevant impacts on weight loss, diet, physical activity and alcohol but they do cost money. Undiagnosed diabetes and developing complications also cost money. Isn’t it time to measure potential health savings from early diagnosis of T2DM in high risk groups?

Professor Annie S Anderson BSc PhD RD FRCP (Edin)

1 Tsilidis Konstantinos K, Kasimis John C, LopezDavid S, Ntzani Evangelia E, Ioannidis John P A. Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies

2 Satija Ambika, Spiegelman Donna, GiovannucciEdward, Hu Frank B. Type 2 diabetes and risk of cancer

3 Steele RJ, Anderson AS, Macleod M, Craigie AM, Caswell S, Belch J, Treweek S. Colorectal adenomas and diabetes: implications for disease prevention.