Forest plot of risk estimates for associations between serum HbA1c levels and risk of gastric cancer after eliminating Ikeda’s study.
Edited by: Liang-Jun Yan, University of North Texas Health Science Center, United States
Reviewed by: Chenfei Jia, Cangzhou Central Hospital, China
*Correspondence: Huawen Xia,
This article was submitted to Clinical Diabetes, a section of the journal Frontiers in Endocrinology
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In a recent systematic review and meta-analysis, Zheng et al. (
The study showed that there was moderate heterogeneity across the studies about associations between HbA1c and the risk of gastric cancer. From the Figure 1 of the study, we can see that among the 5 studies included, only one of them, the Ikeda’s study (from Japan), showed that HbA1c levels >6% increased the risk of gastric cancer, while the other four studies showed no associations between the elevated HbA1c and the risk of gastric cancer. We conducted a sensitivity analysis and found that after excluding Ikeda’s study, heterogeneity across the studies decreased to 0, that was, inter-study heterogeneity disappeared completely, as shown in
Forest plot of risk estimates for associations between serum HbA1c levels and risk of gastric cancer after eliminating Ikeda’s study.
We tried to find the differences between Ikeda’s study and other studies and found that this study had the smallest sample size, with 427 patients with HbA1c at 6.0-6.9% and only 101 patients with HbA1c ≥7%. As we all know, Japan is a country with a high incidence of gastric cancer in the world, and the proportion of people with gastric cancer will undoubtedly be higher than other studies (
Our reconstructed forest plot, based on the data provided by the authors in the paper, showed that elevated HbA1c levels did not increase the risk of gastric cancer, which was different from the authors’ final conclusion. In summary, more evidence from large prospective studies is still needed to confirm the association between elevated level of HbA1c and risk of gastric cancer.
YW, HW, and HX wrote the letter. All authors contributed to the article and approved the submitted version.
The authors would like to thank the participating members.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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