Association Between Metformin and Sulfonylurea Monotherapies and Cancer Incidence: A Real-World Cohort Study in Shanghai, China

Abstract

IntroductionPrevious studies have shown that patients with type 2 diabetes mellitus have an increased risk of cancer. The use of antidiabetic medication (ADM) may play an important role in the cancer development. The relationship between oral ADM and cancer incidence has not been investigated in type 2 diabetes mellitus patients in mainland China yet.MethodsA community-based diabetes cohort was extracted from the Shanghai Community Diabetes Management System database, which is a patient registry from general practices. The cohort included 2353 newly onset type 2 diabetes mellitus patients from 2006 to 2010 aged 35 years or more. Patients were grouped into nonusers of antidiabetic medication (n = 722), metformin monotherapy (n = 374), sulfonylurea monotherapy (n = 653), metformin and sulfonylurea combination therapy (n = 302), and other medication therapies (n = 302) on the basis of initial treatment type at registry entry. Cancer incidence was identified from the Shanghai Cancer Registry Organization. Comparisons between monotherapy and nonuser of medication were conducted using Cox proportional hazards models.ResultsA total of 94 cancer cases were identified during 5 years median follow-up. Compared with nonusers, sulfonylurea monotherapy was associated with significantly lower risk of cancer [adjusted HR = 0.50 (95% CI 0.29–0.85)] whereas risk was 49% lower with metformin monotherapy [adjusted HR = 0.51 (95% CI 0.27–0.99)].ConclusionThe real-world evidence suggested that the use of metformin or sulfonylurea was associated with lower risk of cancer incidence in a cohort of newly onset type 2 diabetes mellitus patients.

Type 2 Diabetes Mellitus and Cancer: Epidemiology, Physiopathology and Prevention

“…Although no direct tumorigenic properties have been described, two studies have pointed out high risk of cancer in individuals treated with sulfonylureas compared to those treated with glyburide [102] or insulin [103]. In contrast, other studies found no effect [104] or a protective effect [105]. This uncertainty highlights the search for appropriate comparison groups as the current challenge in evaluating the effectiveness of sulfonylureas.…”

Treatment of type 2 diabetes mellitus and risk of pancreatic cancer

“…Ye et al in a population-based cohort study estimated the pancreatic cancer risk in 653 new-onset T2DM patients using Sus and revealed that sulphonylureas monotherapy was associated with significantly lower risk of pancreatic cancer [57].…”

Ocorrência de câncer colorretal em pacientes portadores de diabetes mellitus usuários de um serviço de assistência terciária em oncologia

“…Estudos sugerem que a metformina pode estar associada à redução no risco de câncer (DABROWSKI et al, 2017;KIM et al, 2018;KUO et al, 2019;WEN et al, 2019;YAO et al, 2019;YE et al, 2019) e a melhores prognósticos em pacientes com câncer (GUO et al, 2017;LI et al, 2017b;WAN et al, 2018;SHI et al, 2019).…”