The Supreme Court's View of the Managed Care Industry's Liability for Adverse Patient Outcomes

Abstract

To the Editor: Dr Gapstur and colleagues¹ observed that higher postload plasma glucose levels were associated with an increased relative risk for pancreatic cancer in their sample of patients, most of whom were white. While working with a predominantly Hispanic adult patient population during the last 6 years, I have come across 3 cases of hepatobiliary cancer in patients with diabetes, none of whom had a history of alcoholism or hepatitis. In recent years, there has been a reported increase in the incidence of hepatobiliary cancer, probably related to hepatitis B and C.² One wonders if there is a similar linkage between hepatobiliary neoplasms and hyperglycemia, as there is between the latter and pancreatic malignancy. Is it possible that the insulin-activated insulin-like growth factor 1 receptor³ could have a proliferative effect on disgestive organs other than the pancreas? Because diabetes mellitus is already associated with considerable morbidity, these newfound risks would be added incentives for attaining glycemic control.