Risk of cancer in patients using glucose-lowering agents: a nationwide cohort study of 3.6 million people.
Risk of cancer in patients using glucose-lowering agents: a nationwide cohort study of 3.6 million people.
复制标题
DOI：
10.1136/bmjopen-2011-000433
复制
发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Torp-Pedersen C
中科院分区：
文献类型：
--
作者：
Andersson C;Vaag A;Selmer C;Schmiegelow M;Sørensen R;Lindhardsen J;Gislason GH;Køber L;Torp-Pedersen C
利用丹麦全国行政登记资料研究降糖治疗暴露与癌症风险之间的关系。全国队列研究。丹麦所有的医院。所有1998-2009年年龄≥35岁、初次接受降糖治疗且无癌症史的个体。主要测量结果：1998年至2009年间首次癌症诊断。通过多变量泊松回归模型评估癌症的风险比与个体降糖药暴露的关系。在159 894例开始使用降糖药治疗的患者中，12 789例发生了癌症，发病率为17.4/1000人年。在未使用降糖药的3 447 904人中，293 878人发生了癌症，发病率为7.9/1000人年。使用不同类型的降糖药，包括人胰岛素、胰岛素类似物和磺脲类药物，与未暴露的个体相比，癌症的风险比在多变量调整后在数量上相似且显著增加1.2-1.3。对于大多数药物，作者发现，在治疗的前30天，癌症的最高RR，随后在治疗开始后6-12个月，风险下降接近背景人群的癌症风险。使用大多数降糖药，包括磺脲类药物，与开始治疗后不久癌症风险增加相关，随后背景人群风险下降。这表明这种关系不是因果关系。几项观察性研究表明，胰岛素治疗可能会增加患癌症的风险。如果胰岛素治疗导致/增强癌症的发展，预期RR会随着治疗时间的延长而增加。本研究在360万人中调查了个体降糖药治疗时间与发生癌症的RR之间的关系。使用人胰岛素、胰岛素类似物和磺脲类药物与未使用胰岛素的人相比，患癌症的风险比显著增加1.2-1.3。对于所有药物，在治疗的前30天发现癌症的最高RR。此后，RR迅速下降，在大多数药物治疗仅6-12个月后达到与未暴露个体相当的癌症RR。这强烈表明，先前报道的使用降糖药与癌症风险增加之间的关联并非因果关系。本研究基于完整的全国行政登记，从而减少了选择偏差。缺乏身体质量指数、血糖调节和家族癌症史的测量数据。
To study the association between exposures to glucose-lowering therapy and risk of cancer using the nationwide administrative registers in Denmark. Nationwide cohort study. All hospitals in Denmark. All individuals aged ≥35 years in 1998–2009 who were naive to glucose-lowering treatment and had no history of cancer. Primary measures outcomes: first cancer diagnosis between 1998 and 2009. The RR of cancer as dependent on exposure to individual glucose-lowering agents was assessed by multivariable Poisson regression models. Of 159 894 patients that initiated treatment with glucose-lowering agents, 12 789 developed cancer, incidence rate 17.4/1000 person-years. Of the remaining 3 447 904 individuals not using glucose-lowering agents, 293 878 developed cancer, incidence rate 7.9/1000 person-years. Use of different types of glucose-lowering agents including human insulin, insulin analogues, as well as sulfonylureas were associated with a quantitatively similar and significantly increased RR of cancer of 1.2–1.3 compared with unexposed individuals after multivariable adjustment. For the majority of agents, the authors identified the highest RR of cancer during the first 30 treatment days with a subsequent decline of risk approaching the cancer risk of the background population only 6–12 months after initiation of treatments. Use of most glucose-lowering agents including sulfonylureas was associated with a comparable increased risk of cancer shortly after initiation of treatment and subsequently a decline to the risk of the background population. This suggests that the relation is not causal. Several observational studies have suggested that insulin therapy may increase the risk of cancer. If insulin therapy causes/enhances cancer development, the RR would be expected to increase with longer treatment duration. The present study investigated the association between treatment duration with individual glucose-lowering agents and the RR of developing cancer in 3.6 million individuals. Use of human insulin, insulin analogues and sulfonylureas were associated with a significantly increased RR of cancer of 1.2–1.3 compared with unexposed individuals. For all agents, the highest RR of cancer was found during the first 30 days of treatment. Hereafter, the RR declined rapidly, reaching a RR of cancer comparable to unexposed individuals after only 6–12 months of therapy for most agents. This strongly suggests that a previously reported association between use of glucose-lowering agents and increased risk of cancer is not causal. This study was based on complete and nationwide administrative registers, thereby reducing selection bias. Data on measurements on body mass index, glucose regulation and family cancer history were lacking.
登录
查看更多内容
影响因子：
8.2
作者：
Andersson, C.;Olesen, J. B.;Gislason, G. H.
通讯作者：
Gislason, G. H.
影响因子：
254.7
作者：
Giovannucci, Edward;Harlan, David M.;Yee, Douglas
通讯作者：
Yee, Douglas
影响因子：
8.8
作者：
Macaulay, V M
通讯作者：
Macaulay, V M
临床使用的胰岛素类似物的受体结合与代谢和有丝分裂效力的相关性
影响因子：
7.7
作者：
Kurtzhals, P;Schäffer, L;Trüb, T
通讯作者：
Trüb, T
影响因子：
168.9
作者：
Sorensen, Rikke;Hansen, Morten L.;Gislason, Gunnar H.
通讯作者：
Gislason, Gunnar H.