Cancer incidence in type 2 diabetes patients - first results from a feasibility study of the D2C cohort

Hense, Hans‐Werner; Kajüter, Hiltraud; Wellmann, Jürgen; Batzler, W. U.

doi:10.1186/1758-5996-3-15

Cited by 40 publications

(35 citation statements)

References 16 publications

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“…The risk was also most influential in the younger age group making it reasonable to suspect that this may be attributable to metabolic dysfunction preceding DM diagnosis. Concurrently to previous findings, results from prospective cohort study on German population (26, total of 742 subjects) showed an increased risk of cancer with SIR 1.14 (95% CI; 1.10–1.21), but the duration of diabetes was inversely associated with the cancer risk which was markedly higher within the first year after diabetes diagnosis [43]. …”

Section: Epidemiologysupporting

confidence: 61%

Diabetes and Risk of Cancer

2013

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Diabetes and cancer represent two complex, diverse, chronic, and potentially fatal diseases. Cancer is the second leading cause of death, while diabetes is the seventh leading cause of death with the latter still likely underreported. There is a growing body of evidence published in recent years that suggest substantial increase in cancer incidence in diabetic patients. The worldwide prevalence of diabetes was estimated to rise from 171 million in 2000 to 366 million in 2030. About 26.9% of all people over 65 have diabetes and 60% have cancer. Overall, 8–18% of cancer patients have diabetes. In the context of epidemiology, the burden of both diseases, small association between diabetes and cancer will be clinically relevant and should translate into significant consequences for future health care solutions. This paper summarizes most of the epidemiological association studies between diabetes and cancer including studies relating to the general all-site increase of malignancies in diabetes and elevated organ-specific cancer rate in diabetes as comorbidity. Additionally, we have discussed the possible pathophysiological mechanisms that likely may be involved in promoting carcinogenesis in diabetes and the potential of different antidiabetic therapies to influence cancer incidence.

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Section: Epidemiologysupporting

confidence: 61%

Diabetes and Risk of Cancer

2013

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“…The association between the use of metformin and the risk of any malignancy was described in 25 studies recruiting 579,621 patients, 7 RCTs (17,785 patients) [24,44,64,65,67,69], and 18 observational studies (561,836 patients) [25-27,30,33,36,37,46,47,50,51,53,55,57,62,70,71,73] (Figure 2B). …”

Section: Resultsmentioning

confidence: 99%

Metformin Therapy and Risk of Cancer in Patients with Type 2 Diabetes: Systematic Review

et al. 2013

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Aims/HypothesisDiabetes treatments were related with either an increased or reduced risk of cancer. There is ongoing debate about a potential protective action of metformin. To summarize evidence on the association between metformin and risk of cancer and cancer mortality in patients with diabetes.MethodsData source: MEDLINE and EMBASE (January 1966-April 2012). We selected randomized studies comparing metformin and other hypoglycaemic agents and observational studies exploring the association between exposure to metformin and cancer. Outcomes were cancer mortality, all malignancies and site-specific cancers.ResultsOf 25307 citations identified, 12 randomized controlled trials (21,595 patients) and 41 observational studies (1,029,389 patients) met the inclusion criteria. In observational studies there was a significant association of exposure to metformin with the risk of cancer death [6 studies, 24,410 patients, OR:0.65, 95%CI: 0.53-0.80], all malignancies [18 studies, 561,836 patients, OR:0.73, 95%CI: 0.61-0.88], liver [8 studies, 312,742 patients, OR:0.34; 95%CI: 0.19-0.60] colorectal [12 studies, 871,365 patients, OR:0.83, 95%CI: 0.74–0.92], pancreas [9 studies, 847,248 patients, OR:0.56, 95%CI: 0.36–0.86], stomach [2 studies, 100701 patients, OR:0.83, 95%CI: 0.76–0.91], and esophagus cancer [2 studies, 100694 patients, OR:0.90, 95%CI: 0.83–0.98]. No significant difference of risk was observed in randomized trials. Metformin was not associated with the risk of: breast cancer, lung cancer, ovarian cancer, uterus cancer, prostate cancer, bladder cancer, kidney cancer, and melanoma.Conclusions/InterpretationResults suggest that Metformin might be associated with a significant reduction in the risk of cancer and cancer-related mortality. Randomized trials specifically designed to evaluate the efficacy of metformin as an anticancer agent are warranted.

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“…In addition, we excluded patients who were on TZD and/or insulin to better assess the association between metformin and PCa risk by eliminating potential confounding effects of other glucose-lowering medications that could themselves have an effect on PCa incidence or progression, as reported in the literature (31–33). …”

Section: Methodsmentioning

confidence: 99%

Statin Use as a Moderator of Metformin Effect on Risk for Prostate Cancer Among Type 2 Diabetic Patients

et al. 2012

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OBJECTIVEMetformin and statins have shown promise for cancer prevention. This study assessed whether the effect of metformin on prostate cancer (PCa) incidence varied by statin use among type 2 diabetic patients.RESEARCH DESIGN AND METHODSThe study cohort consisted of 5,042 type 2 diabetic male patients seen in the Veteran Administration Health Care System who were without prior cancer and were prescribed with metformin or sulfonylurea as the exclusive hypoglycemic medication between fiscal years 1999 and 2005. Cox proportional hazards analyses were conducted to assess the differential hazard ratio (HR) of PCa due to metformin by statin use versus sulfonylurea use, where propensity scores of metformin and statin use were adjusted to account for imbalances in baseline covariates across medication groups.RESULTSMean follow-up was ∼5 years, and 7.5% had a PCa diagnosis. Statin use modified the effect of metformin on PCa incidence (P < 0.0001). Metformin was associated with a significantly reduced PCa incidence among patients on statins (HR 0.69 [95% CI 0.50–0.92]; 17 cases/533 metformin users vs. 135 cases/2,404 sulfonylureas users) and an increased PCa incidence among patients not on statins (HR 2.15 [1.83–2.52]; 22 cases/175 metformin users vs. 186 cases/1,930 sulfonylureas users). The HR of PCa incidence for those taking metformin and statins versus those taking neither medication was 0.32 (0.25–0.42).CONCLUSIONSAmong men with type 2 diabetes, PCa incidence among metformin users varied by their statin use. The potential beneficial influence on PCa by combination use of metformin and statin may be due to synergistic effects.

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Cancer incidence in type 2 diabetes patients - first results from a feasibility study of the D2C cohort

Cited by 40 publications

References 16 publications

Diabetes and Risk of Cancer

Diabetes and Risk of Cancer

Metformin Therapy and Risk of Cancer in Patients with Type 2 Diabetes: Systematic Review

Statin Use as a Moderator of Metformin Effect on Risk for Prostate Cancer Among Type 2 Diabetic Patients

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