Metformin associated with lower cancer mortality in type 2 diabetes: ZODIAC-16.
Metformin associated with lower cancer mortality in type 2 diabetes: ZODIAC-16.
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DOI：
10.2337/dc09-1380
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发表时间：
2010-02
期刊：
影响因子：
16.2
通讯作者：
Bilo HJ
中科院分区：
文献类型：
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作者：
Landman GW;Kleefstra N;van Hateren KJ;Groenier KH;Gans RO;Bilo HJ
多项研究表明特定的糖尿病治疗与癌症死亡率之间存在关联。我们在前瞻性随访队列中研究了二甲双胍的使用与癌症死亡率之间的关联。 1998年和1999年，1,353名2型糖尿病患者参加了荷兰兹沃勒门诊糖尿病项目整合可用护理（ZODIAC）研究。生命状况于 2009 年 1 月进行了评估。使用标准化死亡率 (SMR) 评估了癌症死亡率，并使用 Cox 比例风险模型评估了二甲双胍使用与癌症死亡率之间的关联，并考虑了可能的混杂因素。中位随访时间为 9.6 年，基线平均年龄为 68 岁，平均 A1C 为 7.5%。患者中有570人死亡，其中122人死于恶性肿瘤。癌症死亡率的 SMR 为 1.47 (95% CI 1.22–1.76)。与基线时未服用二甲双胍的患者相比，服用二甲双胍的患者癌症死亡率的调整后风险比 (HR) 为 0.43 (95% CI 0.23–0.80)，二甲双胍每增加 1 g，HR 为 0.58 (95% CI 0.36–0.93)。一般来说，2 型糖尿病患者的癌症死亡风险较高。在我们的小组中，与不使用二甲双胍相比，使用二甲双胍与较低的癌症死亡率相关。尽管该设计无法提供因果关系的结论，但我们的结果表明二甲双胍对癌症死亡率具有保护作用。
Several studies have suggested an association between specific diabetes treatment and cancer mortality. We studied the association between metformin use and cancer mortality in a prospectively followed cohort. In 1998 and 1999, 1,353 patients with type 2 diabetes were enrolled in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study in the Netherlands. Vital status was assessed in January 2009. Cancer mortality rate was evaluated using standardized mortality ratios (SMRs), and the association between metformin use and cancer mortality was evaluated with a Cox proportional hazards model, taking possible confounders into account. Median follow-up time was 9.6 years, average age at baseline was 68 years, and average A1C was 7.5%. Of the patients, 570 died, of which 122 died of malignancies. The SMR for cancer mortality was 1.47 (95% CI 1.22–1.76). In patients taking metformin compared with patients not taking metformin at baseline, the adjusted hazard ratio (HR) for cancer mortality was 0.43 (95% CI 0.23–0.80), and the HR with every increase of 1 g of metformin was 0.58 (95% CI 0.36–0.93). In general, patients with type 2 diabetes are at increased risk for cancer mortality. In our group, metformin use was associated with lower cancer mortality compared with nonuse of metformin. Although the design cannot provide a conclusion about causality, our results suggest a protective effect of metformin on cancer mortality.