Glucose-lowering agents and the patterns of risk for cancer: a study with the General Practice Research Database and secondary care data

Staa, Tjeerd van; Patel, Deven; Gallagher, Arlene M.; Bruin, Marie L. De

doi:10.1007/s00125-011-2390-3

Cited by 110 publications

(114 citation statements)

References 32 publications

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“…1). Following our inclusion criteria, 16 cohort and 3 case-control studies were included in this systematic review (5)(6)(7)(8)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). All studies evaluated insulin glargine, with four studies also investigating insulin detemir (15,17,25,28).…”

Section: Study Selectionmentioning

confidence: 99%

“…Thirteen studies examined ever use of long-acting insulin analogs, which was defined as at least one prescription, compared with nonuse, other, human, or NPH insulin (5)(6)(7)(8)14,16,18,19,21,23,(25)(26)(27). One study examined duration of time since starting long-acting insulin analogs, and one examined mean daily dose (22,28). Four studies used time-dependent exposure definitions (15,17,20,24).…”

Section: Study Characteristics and Effect Estimatesmentioning

confidence: 99%

“…1 and Supplementary Fig. 2) (5,8,(14)(15)(16)(17)(19)(20)(21)23,25,26,28). Four of 13 studies reported an association of insulin glargine and breast cancer (8,19,21,24).…”

Section: Study Characteristics and Effect Estimatesmentioning

confidence: 99%

“…Time-lag bias may have occurred in four studies that compared insulin glargine to human or other (nonbasal) insulin or highest-to-lowest duration of insulin use without adjusting or matching on diabetes duration (7,14,23,28). The presence of time-lag bias is well illustrated in a cohort study in which individuals who received human insulin or any type of insulin analog for the first time were included in the cohort.…”

Section: Time-lag Biasmentioning

confidence: 99%

“…These studies raised important concerns but were also criticized for important methodological shortcomings (9)(10)(11)(12)(13). Since then, several observational studies assessing the association between longacting insulin analogs and cancer have been published but yielded inconsistent findings (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Such discrepancies may be due to methodological limitations, including inadequate durations of followup between insulin initiation and cancer incidence, protopathic bias, detection bias, the inclusion of prevalent users, and time-related biases such as immortal time bias, time-window bias, and time-lag bias (29).…”

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confidence: 99%

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Effect of Long-Acting Insulin Analogs on the Risk of Cancer: A Systematic Review of Observational Studies

Filion

Azoulay

et al. 2016

Diabetes Care

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OBJECTIVEObservational studies examining the association between long-acting insulin analogs and cancer incidence have produced inconsistent results. We conducted a systematic review of these studies, focusing on their methodological strengths and weaknesses. RESEARCH DESIGN AND METHODSWe systematically searched MEDLINE and EMBASE from 2000 to 2014 to identify all observational studies evaluating the relationship between the long-acting insulin analogs and the risk of any and site-specific cancers (breast, colorectal, prostate). We included cohort and case-control studies published in English on insulin glargine and detemir and any cancer incidence among patients with type 1 or 2 diabetes. The methodological assessment involved the inclusion of prevalent users, inclusion of lag periods, time-related biases, and duration of follow-up between insulin initiation and cancer incidence. RESULTSA total of 16 cohort and 3 case-control studies met our inclusion criteria. All studies evaluated insulin glargine, and four studies also examined insulin detemir. Follow-up ranged from 0.9 to 7.0 years. Thirteen of 15 studies reported no association between insulin glargine and detemir and any cancer. Four of 13 studies reported an increased risk of breast cancer with insulin glargine. In the quality assessment, 7 studies included prevalent users, 11 did not consider a lag period, 6 had time-related biases, and 16 had short (<5 years) follow-up. CONCLUSIONSThe observational studies examining the risk of cancer associated with long-acting insulin analogs have important methodological shortcomings that limit the conclusions that can be drawn. Thus, uncertainty remains, particularly for breast cancer risk.NPH insulin has been the mainstay treatment for type 1 diabetes and advanced type 2 diabetes since the 1950s. However, this insulin is associated with an increased risk of nocturnal hypoglycemia, and its relatively short half-life requires frequent administration (1,2). Consequently, structurally modified insulins, known as longacting insulin analogs (glargine and detemir), were developed in the 1990s to circumvent these limitations. However, there are concerns that long-acting insulin

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristics and Effect Estimatesmentioning

confidence: 99%

“…1 and Supplementary Fig. 2) (5,8,(14)(15)(16)(17)(19)(20)(21)23,25,26,28). Four of 13 studies reported an association of insulin glargine and breast cancer (8,19,21,24).…”

Section: Study Characteristics and Effect Estimatesmentioning

confidence: 99%

Section: Time-lag Biasmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Long-Acting Insulin Analogs on the Risk of Cancer: A Systematic Review of Observational Studies

Filion

Azoulay

et al. 2016

Diabetes Care

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Funding Data from Publication Acknowledgments: Coverage, Uses, and Limitations

Grassano

Rotolo

Hutton

et al. 2016

Asso for Info Science & Tech

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This article contributes to the development of methods for analysing research funding systems by exploring the robustness and comparability of emerging approaches to generate funding landscapes useful for policy making. We use a novel data set of manually extracted and coded data on the funding acknowledgements of 7,510 publications representing UK cancer research in the year 2011 and compare these “reference data” with funding data provided by Web of Science (WoS) and MEDLINE/PubMed. Findings show high recall (around 93%) of WoS funding data. By contrast, MEDLINE/PubMed data retrieved less than half of the UK cancer publications acknowledging at least one funder. Conversely, both databases have high precision (+90%): That is, few cases of publications with no acknowledgment to funders are identified as having funding data. Nonetheless, funders acknowledged in UK cancer publications were not correctly listed by MEDLINE/PubMed and WoS in around 75% and 32% of the cases, respectively. Reference data on the UK cancer research funding system are used as a case study to demonstrate the utility of funding data for strategic intelligence applications (e.g., mapping of funding landscape and co‐funding activity, comparison of funders' research portfolios).

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Thiazolidinedione therapy and breast cancer risk in diabetic women: A systematic review and meta‐analysis

Lin

Cheng

et al. 2017

Diabetes Metabolism Res

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Rising experimental evidence suggests that thiazolidinediones (TZDs) exert a protective effect on breast cancer. However, studies concerning this issue were inconsistent and limited. Hence, we performed a meta-analysis with data from currently available studies to evaluate the effect of TZDs on breast cancer risk among diabetic women. We comprehensively searched for all pertinent studies addressing TZDs use and breast cancer risk published before January 1, 2016, in PubMed, Clinical Trials, and Cochrane Library. Data synthesis was performed in a random-effects model using Stata version 12.0 (Stata Corp, College Station, Texas). Fourteen independent studies were eventually selected in this meta-analysis, including 5 randomized controlled clinical trials (RCTs), 7 cohort studies, and 2 case-control studies. No significant associations of TZD use and risk of breast cancer were observed in the RCTs (pooled risk ratio [RR]: 0.77, 95% confidence interval (CI), 0.39-1.53, I = 26%) or case-control studies (pooled odds ratio, 0.99, 95% CI, 0.76-1.28, I = 31%). A 19% reduction in breast cancer risk (pooled RR: 0.81, 95% CI, 0.66-0.99, I = 72%) was found in the cohort studies. However, after removing the study with the smallest event number and the greatest effect size, the association became nonsignificant with greatly decreased heterogeneity (pooled RR: 0.94, 95% CI, 0.86-1.03, I = 16%). This meta-analysis did not find any significant association between TZDs use and risk of breast cancer among diabetic women.

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Glucose-lowering agents and the patterns of risk for cancer: a study with the General Practice Research Database and secondary care data

Cited by 110 publications

References 32 publications

Effect of Long-Acting Insulin Analogs on the Risk of Cancer: A Systematic Review of Observational Studies

Effect of Long-Acting Insulin Analogs on the Risk of Cancer: A Systematic Review of Observational Studies

Funding Data from Publication Acknowledgments: Coverage, Uses, and Limitations

Thiazolidinedione therapy and breast cancer risk in diabetic women: A systematic review and meta‐analysis

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