Differences in clinical profiles and cancer incidence among patients with type 2 diabetes in primary care: Comparison between multidisciplinary and usual management

Background: Multidisciplinary diabetes management has been designed to reduce the risk of diabetes-associated complications. Nevertheless, it remains underexplored whether multidisciplinary management may provide the added benefits of lowering cancer risk. This study aims to compare differences in clinical profiles and cancer incidence between patients receiving multidisciplinary and standard management in primary care. Methods: This retrospective cohort study identified patients who attended general outpatient clinics between year 1997 and 2021 without cancer history using territory-wide electronic health records of Hong Kong. Patients were followed up until December 31st, 2021. Cox regression weighted with inverse probability of treatment was applied to compare the risk of site-specific cancers (colon and rectum, liver, pancreas, stomach, bladder, kidney, and lung) between patients with usual diabetes care (n=25,301), multidisciplinary diabetes management (n=66,382), and those without diabetes (n=54,376). Results: The risk of developing liver and pancreatic cancers appeared to be attenuated in patients who received multidisciplinary diabetes care, when compared to those with usual care alone (aHRs for liver: 1.90, 95%CI 1.26-2.86 vs 2.26, 95%CI 1.47-3.46; pancreas: 3.47, 95%CI 1.41-8.53 vs 5.57, 95%CI 2.15-14.45), with reference to non-diabetes. Patients with usual diabetes care showed a higher risk of gastric cancer in unweighted model, but the association disappeared in weighted model. Overall, patients who received multidisciplinary diabetes management tended to be younger with less comorbidities. Conclusion: The risk of liver and pancreatic cancers appeared to be mitigated in patients receiving multidisciplinary diabetes care. Further studies are warranted to evaluate whether multidisciplinary management may provide additional benefits of cancer prevention.