Intensive glycaemic control and cancer risk in type 2 diabetes: a meta-analysis of major trials
Intensive glycaemic control and cancer risk in type 2 diabetes: a meta-analysis of major trials
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DOI：
10.1007/s00125-010-1933-3
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发表时间：
2011-01-01
期刊：
影响因子：
8.2
通讯作者：
Bowker, S. L.
中科院分区：
文献类型：
--
作者：
Johnson, J. A.;Bowker, S. L.
本研究的目的是探讨2型糖尿病高血糖与癌症发病风险和癌症死亡率的关系。我们有兴趣确定主要随机对照试验的数据是否支持改善血糖控制可能降低癌症风险的假设，我们纳入了主要随机对照试验，其总体目标是加强2型糖尿病的血糖控制。我们从已发表的论文和补充材料中提取数据，并对癌症死亡率和癌症发病率进行了单独的荟萃分析。（53，892人-年中222起事件）和标准对照（38，743人-年发生155起事件）（英国前瞻性糖尿病研究[UKPDS] 33、UKPDS 34、控制糖尿病心血管风险的行动[雅阁]和退伍军人事务部糖尿病试验[VADT]）;癌症死亡率的综合风险比为1.00（95%CI 0.81-1.24; I（2）= 0%）。排除UKPDS二甲双胍试验后，合并风险估计值为1.03（95% CI 0.83-1.29; I（2）= 0%）。三项试验报告了研究组的癌症发病率（糖尿病和血管疾病的作用：Preterax和Diamicron MR对照评价[ADVANCE]、吡格列酮在大血管事件中的前瞻性临床试验[PROactive]、罗格列酮在糖尿病中的心脏结局和血糖调节评价[RECORD]），47，974人-年中有357起事件，血糖控制改善，45人-年中有380起事件，对照组的合并风险比为0.91（95%CI 0.79-1.05; I（2）= 0%）。来自强化血糖控制的大型随机对照试验的数据表明，改善2型糖尿病的血糖控制并不能降低癌症风险。因此，这些数据不支持高血糖症与癌症风险增加有因果关系的假设。
The purpose of this study was to explore the relationship between hyperglycaemia in type 2 diabetes and risk of cancer incidence or cancer mortality. We were interested to determine if data from major randomised controlled trials would support a hypothesis that improving glycaemic control may reduce the risk of cancer outcomes.We included major randomised controlled trials conducted with an overall aim of intensified glycaemic control in type 2 diabetes. We abstracted data from published papers and supplemental material and conducted separate meta-analyses of cancer mortality and cancer incidence.Four trials reported cancer mortality for the intensive (222 events in 53,892 person-years) and standard control (155 events in 38,743 person-years) arms (UK Prospective Diabetes Study [UKPDS] 33, UKPDS 34, Action to Control Cardiovascular Risk in Diabetes [ACCORD] and Veterans Affairs Diabetes Trial [VADT]); the summary risk ratio for cancer mortality was 1.00 (95% CI 0.81-1.24; I (2) = 0%). Excluding the UKPDS metformin trial resulted in a pooled risk estimate of 1.03 (95% CI 0.83-1.29; I (2) = 0%). Three trials reported cancer incidence for the study arms (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation [ADVANCE], PROspective pioglitAzone Clinical Trial In macroVascular Events [PROactive], Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes [RECORD]) with 357 events in 47,974 person-years with improved glycaemic control and 380 events in 45,009 person-years in the control arms; the pooled risk ratio for cancer incidence was 0.91 (95% CI 0.79-1.05; I (2) = 0%).Data from large randomised controlled trials of intensified glycaemic control suggest that cancer risk is not reduced by improving glycaemic control in type 2 diabetes. These data therefore do not support the hypothesis that hyperglycaemia is causally linked to increased cancer risk.