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Anti-diabetic treatment and cancer occurrence among patients with type II diabetes mellitus.

机译：II型糖尿病患者的抗糖尿病治疗和癌症发生。

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摘要

This is a retrospective cohort study, with nested case-control analyses, of type II diabetes patients, to evaluate the association between anti-diabetic treatment and cancer incidence. Methods: Patients who were initially stabilized on an oral hypoglycemic agent (OHA) mono-therapy, including metformin, sulfonylurea, TZD, and meglitinides, in the GPRD were included in the cohort. New diagnoses of cancer during cohort follow up were compared among exposure groups. In addition to the cohort analyses, solid tumors, as well as breast cancer and colorectal cancer, identified during the cohort follow-up were matched to controls and case-control analyses were performed within the cohort.;Results: Compared to metformin, there was no difference in risk of malignant solid tumors or hematological malignancy with other major classes of OHAs in the cohort. The case-control analyses further supported the findings that these OHA classes or their combinations did not alter the risk of malignant solid tumors.;In the case-control analyses, exposure to insulin was associated with a 64% (95% CI: 1.24, 2.16) higher risk of malignant solid tumors and this risk was modified when combined with different OHAs. When sulfonylurea was added to insulin, the risk of cancer was increased to almost 3 times (OR = 2.75, 95% CI: 1.51, 5.03), while adding metformin to insulin changed the odds ratio to 1.35 (95% CI: 0.94, 1.94). Similar results were found for breast cancer in which insulin was associated with a significant increase of more than 2 times in risk and other OHAs without insulin were not related to altered risk. For colorectal cancer (CRC), both sulfonylurea and TZD were associated with around a 2-fold significant risk increase compared to metformin. The odds of developing CRC were also elevated after starting insulin (OR = 1.41), although this did not reach statistical significance in these data.;Conclusion: This study provides evidence that neither sulfonylurea nor TZD substantially alter the risk of solid tumor compared to metformin among type II diabetes patients. Insulin is associated with higher risk of cancer and this risk may be diminished by concomitant use of metformin, but appears to be magnified by concomitant use of sulfonylurea.
机译：这是一项回顾性队列研究，通过嵌套病例对照分析对II型糖尿病患者进行评估，以评估抗糖尿病治疗与癌症发生率之间的关联。方法：该队列包括最初在GPRD中采用口服降糖药（OHA）单一疗法稳定的患者，包括二甲双胍，磺酰脲，TZD和美格替尼。在暴露人群中比较了队列随访期间的新癌症诊断。除了队列分析外，队列随访期间发现的实体瘤以及乳腺癌和结直肠癌也与对照组匹配，并在队列内进行了病例对照分析。结果：与二甲双胍相比，存在与该队列中其他主要类别的OHA相比，恶性实体瘤或血液系统恶性肿瘤的风险无差异。病例对照分析进一步支持了以下发现：这些OHA类或它们的组合不会改变恶性实体瘤的风险。在病例对照分析中，胰岛素暴露与64％（95％CI：1.24， 2.16）发生恶性实体瘤的风险更高，与不同的OHA联合使用时，这种风险得到了改善。当将磺酰脲添加到胰岛素中时，罹患癌症的风险增加到几乎3倍（OR = 2.75，95％CI：1.51，5.03），而在胰岛素中添加二甲双胍则将比值比更改为1.35（95％CI：0.94，1.94） ）。在乳腺癌中发现了类似的结果，其中胰岛素与风险显着增加两倍以上相关，而其他没有胰岛素的OHA与风险改变无关。对于大肠癌（CRC），与二甲双胍相比，磺酰脲类药物和TZD均与约2倍的显着风险增加相关。开始胰岛素治疗后发生CRC的几率也增加了（OR = 1.41），尽管在这些数据中没有统计学意义。结论：这项研究提供的证据表明，与二甲双胍相比，磺脲类药物和TZD均不会显着改变实体瘤的风险在II型糖尿病患者中。胰岛素与较高的癌症风险相关，同时使用二甲双胍可以降低这种风险，但同时使用磺酰脲似乎会加剧这种风险。

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  • 作者

    Qiu, Hong.;

  • 作者单位

    Rutgers The State University of New Jersey - New Brunswick and University of Medicine and Dentistry of New Jersey.;

  • 授予单位 Rutgers The State University of New Jersey - New Brunswick and University of Medicine and Dentistry of New Jersey.;
  • 学科 Health Sciences Pharmacy.;Health Sciences Public Health.;Health Sciences Epidemiology.;Health Sciences Oncology.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 87 p.
  • 总页数 87
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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