Associations of hyperglycemia and insulin usage with the risk of cancer in type 2 diabetes: the Hong Kong diabetes registry.
Associations of hyperglycemia and insulin usage with the risk of cancer in type 2 diabetes: the Hong Kong diabetes registry.
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作者：
Yang X;Ko GT;So WY;Ma RC;Yu LW;Kong AP;Zhao H;Chow CC;Tong PC;Chan JC
尽管高血糖可能是 2 型糖尿病癌症的危险因素，但胰岛素具有促有丝分裂作用。目前尚不清楚胰岛素的使用是否会因为其对细胞生长和增殖的影响而增加癌症风险，或者是否因为其降血糖作用而降低癌症风险。从年龄（±3岁）、吸烟状况和开始胰岛素治疗的可能性（±0.05）1:2匹配的新胰岛素使用者队列中，选取了4,623名患有2型糖尿病、未患癌症且在入组时未曾接受过胰岛素治疗的中国2型糖尿病患者。对配对的分层 Cox 回归分析用于获得胰岛素治疗和 A1C 的癌症风险风险比 (HR)。使用结构化调整方案来调整协变量。在 973 名新胰岛素使用者中，有 971 名与非使用者相匹配 (n = 1935)。非胰岛素使用者的癌症发病率远高于胰岛素使用者（每 1000 人年 49.2 比 10.2，P < 0.0001）。对 P 值小于 0.3 的所有其他协变量以及与癌症的非线性关联进行进一步调整后，A1C 与癌症风险增加相关（每百分比 HR 1.26，95% CI 1.03–1.55），而胰岛素的使用与癌症风险降低相关（胰岛素使用者与非使用者的 HR：0.17、0.09–0.32）。对所有 973 名胰岛素使用者和 3,650 名非使用者进行的分析发现了一致的结果。在中国 2 型糖尿病患者中，高血糖可预测癌症，而胰岛素的使用与癌症风险降低相关。
Insulin has mitogenic effects, although hyperglycemia may be a risk factor for cancer in type 2 diabetes. It remains uncertain whether use of insulin increases cancer risk because of its effect on cell growth and proliferation or decreases cancer risk because of its glucose-lowering effect. A 1:2-matched new insulin user cohort on age (±3 years), smoking status, and likelihood of initiating insulin therapy (±0.05) was selected from a cohort of 4,623 Chinese patients with type 2 diabetes, free of cancer, and naive to insulin at enrollment. Stratified Cox regression analysis on the matched pairs was used to obtain hazard ratios (HRs) of insulin therapy and A1C for cancer risk. A structured adjustment scheme was used to adjust for covariates. Of 973 new insulin users, 971 had matched nonusers (n = 1935). The cancer incidence in insulin nonusers was much higher than that in insulin users (49.2 vs. 10.2, per 1,000 person-years, P < 0.0001). After further adjustment for all other covariates with a P value less than 0.3 and nonlinear associations with cancer, A1C was associated with an increased cancer risk (HR per percentage 1.26, 95% CI 1.03–1.55), whereas use of insulin was associated with a decreased cancer risk (HR of insulin users vs. nonusers: 0.17, 0.09–0.32). Consistent results were found in analyses including all 973 insulin users and 3,650 nonusers. In Chinese patients with type 2 diabetes, hyperglycemia predicts cancer, whereas insulin usage was associated with a reduced cancer risk.
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