Cancer Incidence and Mortality in Patients with Type 2 Diabetes Treated with Human Insulin: A Cohort Study in Shanghai

Abstract

AimThe aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.MethodsWe recruited 8,774 insulin-naïve diabetes patients from the Shanghai Diabetes Registry (SDR). The follow-up rate was 85.4%. All subjects were divided into the insulin use cohort (n = 3,639) and the non-insulin use cohort (n = 5,135). The primary outcome was the first diagnosis of any cancer. The secondary outcome was all-cause mortality. Cox proportional hazards model was used to estimate the relative risk (RR) of cancer and mortality.ResultsWe observed 98 cancer events in the insulin use cohort and 170 in the non-insulin use cohort. Cancer incidence rates were 78.6 and 74.3 per 10,000 patients per year in the insulin users and the non-insulin users, respectively. No significant difference in cancer risk was observed between the two cohorts (adjusted RR = 1.20, 95% CI 0.89–1.62, P = 0.228). Regarding site-specific cancers, only the risk of liver cancer was significantly higher in the insulin users compared to that in the non-insulin users (adjusted RR = 2.84, 95% CI 1.12–7.17, P = 0.028). The risks of overall mortality (adjusted RR = 1.89, 95% CI 1.47–2.43, P<0.0001) and death from cancer (adjusted RR = 2.16, 95% CI 1.39–3.35, P = 0.001) were all significantly higher in the insulin users than in the non-insulin users.ConclusionThere was no excess risk of overall cancer in patients with type 2 diabetes who were treated with human insulin. However, a significantly higher risk of liver cancer was found in these patients. Moreover, insulin users showed higher risks of overall and cancer mortality. Considering that individuals treated with insulin were more likely to be advanced diabetic patients, caution should be used in interpreting these results.

Anti-Diabetic Medications Do Not Influence Risk of Lung Cancer in Patients with Diabetes Mellitus: a Systematic Review and Meta-analysis

“…Diabetes mellitus has been associated with a decreased risk of lung cancer in some (Rousseau et al, 2006;Ogunleye et al, 2009;Atchison et al, 2011) but not all studies (Hall et al, 2005;Ehrlich et al, 2010;Lai et al, 2012), a finding which may be explained by different smoking habits. Furthermore, it was reported that diabetic patients using metformin plus any other treatment had a lung cancer risk that was 37% lower than those not using the anti-diabetes drug (Hall et al, 2005).…”

“…Furthermore, it was reported that diabetic patients using metformin plus any other treatment had a lung cancer risk that was 37% lower than those not using the anti-diabetes drug (Hall et al, 2005).…”

“…In studies on risk of lung cancer, some studies suggest that metformin and TZDs may be chemopreventive in patients with DM Lai et al, 2012;Ruiter et al, 2012), whereas others show no beneficial effect Mazzone et al, 2012). Likewise, some studies suggest that SUs and insulin may promote risk of lung cancer Hsieh et al, 2012), whereas others show no harmful effects Gu et al, 2013).…”

“…Of the total 2595 unique studies identified using the search strategy, 15 Libby et al, 2009;Ferrara et al, 2011;Chang et al, 2012;Hsieh et al, 2012;Lai et al, 2012;Luo et al, 2012;Mazzone et al, 2012;Ruiter et al, 2012;van Staa et al, 2012;Gu et al, 2013;Wang et al, 2013) studies fulfilled the inclusion criteria and were pooled in the meta-analysis (Figure 1). The characteristics of these studies are shown in Table Figure :http://dx.doi.org/10.7314/APJCP.2014.15.16.6863 Antidiabetic Medications and Lung Cancer Risk in DM Sufferers Quantitative Synthesis and Test of Heterogeneity (1) Metformin and risk of lung cancer On meta-analysis of all observational studies assessing the risk of lung cancer in patients with DM, use of metformin (as compared with non-use) did not show a significant association with lung cancer in patients with DM ( n=11 studies; adjusted OR=0.99, 95%CI: 0.87-1.12), and this was stable across different study designs (Figure 2 ).…”

Diabetes and cancer: A critical appraisal of the pathogenetic and therapeutic links

“…Notably, while the physiological pattern of insulin secretion to the portal vein includes degradation and utilization of a significant proportion of the hormone in the liver, exogenous administration allows higher availability of insulin to the peripheral tissues (12). However, a Chinese cohort study demonstrated that there was no excess risk of overall cancer in T2DM patients treated with human insulin, regardless of an increased overall and cancer mortality among insulin users (29).…”