Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai.
Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai.
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DOI：
10.1371/journal.pone.0053411
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Jia W
中科院分区：
文献类型：
--
作者：
Gu Y;Wang C;Zheng Y;Hou X;Mo Y;Yu W;Zhang L;Hu C;Nan H;Chen L;Li J;Liu Y;Huang Z;Han M;Bao Y;Zhong W;Jia W
目的是研究中国2型糖尿病患者中人胰岛素与癌症发病率和死亡率之间的关系。我们从上海糖尿病登记中心（SDR）招募了8，774名胰岛素初治糖尿病患者。随访率为85.4%。所有受试者被分为胰岛素使用队列（n = 3，639）和非胰岛素使用队列（n = 5，135）。 主要结局是首次诊断出任何癌症。次要结局为全因死亡率。采用考克斯比例风险模型估计癌症和死亡的相对危险度。我们在使用胰岛素的队列中观察到98例癌症事件，在非胰岛素使用队列中观察到170例。胰岛素使用者和非胰岛素使用者的癌症发病率分别为每年每10，000名患者78.6和74.3。两个队列之间未观察到癌症风险的显著差异（校正RR = 1.20，95%CI 0.89-1.62，P = 0.228）。 关于部位特异性癌症，只有肝癌的风险在胰岛素使用者中显著高于非胰岛素使用者（调整后的RR = 2.84，95%CI 1.12-7.17，P = 0.028）。 总死亡率（校正RR = 1.89，95% CI 1.47-2.43，P<0.0001）和癌症死亡（校正RR = 2.16，95% CI 1.39-3.35，P = 0.001）的风险均显著高于非胰岛素使用者。 在接受人胰岛素治疗的2型糖尿病患者中，总体癌症风险没有增加。然而，在这些患者中发现肝癌的风险显著较高。此外，胰岛素使用者总体死亡率和癌症死亡率的风险较高。考虑到接受胰岛素治疗的个体更可能是晚期糖尿病患者，在解释这些结果时应谨慎。
The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes. We recruited 8,774 insulin-naïve diabetes patients from the Shanghai Diabetes Registry (SDR). The follow-up rate was 85.4%. All subjects were divided into the insulin use cohort (n = 3,639) and the non-insulin use cohort (n = 5,135). The primary outcome was the first diagnosis of any cancer. The secondary outcome was all-cause mortality. Cox proportional hazards model was used to estimate the relative risk (RR) of cancer and mortality. We observed 98 cancer events in the insulin use cohort and 170 in the non-insulin use cohort. Cancer incidence rates were 78.6 and 74.3 per 10,000 patients per year in the insulin users and the non-insulin users, respectively. No significant difference in cancer risk was observed between the two cohorts (adjusted RR = 1.20, 95% CI 0.89–1.62, P = 0.228). Regarding site-specific cancers, only the risk of liver cancer was significantly higher in the insulin users compared to that in the non-insulin users (adjusted RR = 2.84, 95% CI 1.12–7.17, P = 0.028). The risks of overall mortality (adjusted RR = 1.89, 95% CI 1.47–2.43, P<0.0001) and death from cancer (adjusted RR = 2.16, 95% CI 1.39–3.35, P = 0.001) were all significantly higher in the insulin users than in the non-insulin users. There was no excess risk of overall cancer in patients with type 2 diabetes who were treated with human insulin. However, a significantly higher risk of liver cancer was found in these patients. Moreover, insulin users showed higher risks of overall and cancer mortality. Considering that individuals treated with insulin were more likely to be advanced diabetic patients, caution should be used in interpreting these results.
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