Figure 3.

Possible mechanisms linking diabetes to accelerated cancer development. Binding of insulin to the insulin receptor (IR in the figure), likely IR-A and/or binding of IGF-1 to the IGF-1 receptor activate MAPK and PI3K/AKT signaling pathways leading to increased cell proliferation and decreased apoptosis. Hyperglycemia and chronic inflammation also contribute to cancer progression through other mechanisms. The mechanisms by which HCV promotes the development of HCC were not included in this figure. IGF-1, insulin-like growth factor 1; IGF-1R, insulin-like growth factor 1 receptor; IR-A, insulin receptor A; MAPK, mitogen-activated protein kinase; PI3K, phosphoinositide 3-kinase; AKT, protein kinase B.