Oral Insulin Secretagogues, Insulin, and Cancer Risk in Type 2 Diabetes Mellitus
Oral Insulin Secretagogues, Insulin, and Cancer Risk in Type 2 Diabetes Mellitus
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DOI：
10.1210/jc.2012-1162
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发表时间：
2012-07-01
影响因子：
5.8
通讯作者：
Chuang, Lee-Ming
中科院分区：
文献类型：
--
作者：
Chang, Chia-Hsuin;Lin, Jou-Wei;Chuang, Lee-Ming
背景：高胰岛素血症可能是导致2型糖尿病患者癌症风险增加的机制。目的是评估口服胰岛素促泌剂、胰岛素与癌症发病率之间的关联。
方法：从2000年1月1日至2000年12月31日台湾全民健康保险索赔数据库中确定了共108920例新诊断的2型糖尿病患者。截至2007年12月31日，将发生癌症的患者作为病例，通过风险集抽样选择多达4名年龄和性别匹配的对照。应用逻辑回归模型估计抗糖尿病药物与癌症发病率之间的比值比（OR）和95%置信区间（CI）。
结果：共纳入8194例癌症发病病例和32776例糖尿病对照。发现使用任何胰岛素（OR，1.97；95%CI，1.85 - 2.09）和格列奈类（OR，1.16；95%CI，1.06 - 1.28）总体癌症发病风险显著增加。发现第一代和第二代磺酰脲类药物（OR，1.08；95%CI，1.01 - 1.15）风险显著增加，但第三代药物格列美脲（OR，1.00；95%CI，0.93 - 1.08）则无此情况。使用胰岛素和格列奈类与肝癌、结直肠癌、肺癌、胃癌和胰腺癌的较高风险相关，而磺酰脲类主要与肝癌风险增加相关。
结论：结果表明，磺酰脲类和格列奈类增加了总体癌症风险，但程度低于胰岛素。与癌症风险相关的治疗方法肯定需要进一步研究。（《临床内分泌与代谢杂志》97：E1170 - E1175，2012）
Background: Hyperinsulinemia might be the mechanism leading to an increased cancer risk in patients with type 2 diabetes. The objective was to evaluate the association between oral insulin secretagogues, insulins, and cancer incidence.Methods: A total of 108,920 patients with newly diagnosed type 2 diabetes were identified from the Taiwan National Health Insurance claims database during the period from 1 January 2000 to 31 December 2000. As of 31 December 2007, patients with incident cancer were included as cases, and up to four age- and sex-matched controls were selected by risk-set sampling. Logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (CI) between antidiabetic medication and cancer incidence.Results: A total of 8,194 incident cancer cases and 32,776 diabetic controls were included. A significantly increased risk for overall cancer incidence was found for any use of insulin (OR, 1.97; 95% CI, 1.85-2.09) and glinides (OR, 1.16; 95% CI, 1.06-1.28). Significantly increased risks were found for first-and second-generation sulfonylureas (OR, 1.08; 95% CI, 1.01-1.15), but not for third-generation drug, glimepiride (OR, 1.00; 95% CI, 0.93-1.08). Use of insulin and glinides was associated with higher risks for liver, colorectal, lung, stomach, and pancreas cancer, whereas sulfonylurea was mainly associated with an increased risk of liver cancer.Conclusions: The results showed that sulfonylureas and glinides increased the risk for overall cancer, but to a lesser extent than insulin. Therapies that are associated with cancer risks certainly require further investigation. (J Clin Endocrinol Metab 97: E1170-E1175, 2012)