Insulin glargine and risk of cancer: a cohort study in the French National Healthcare Insurance Database

Abstract

Aims/hypothesisUsing the Echantillon Généraliste de Bénéficiaires: random 1/97 permanent sample of the French national healthcare insurance system database (EGB), we investigated whether, as previously suspected, the risk of cancer in insulin glargine (A21Gly,B31Arg,B32Arg human insulin) users is higher than in human insulin users. The investigation period was from 1 January 2003 to 30 June 2010.MethodsWe used Cox proportional hazards time-dependent models that were stratified on propensity score quartiles for use of insulin glargine vs human insulin, and adjusted for insulin, biguanide and sulfonylurea possession rates to assess the risk of cancer or death in all or incident exclusive or predominant (≥80% use time) users of insulin glargine compared with equivalent human insulin users.ResultsOnly type 2 diabetic patients were studied. Exposure rates varied from 2,273 and 614 patient-years for incident exclusive users of insulin glargine or human insulin, respectively, to 3125 and 2341 patient-years for all patients predominantly using insulin glargine or human insulin, respectively. All-type cancer HRs with insulin glargine vs human insulin ranged from 0.59 (95% CI 0.28, 1.25) in incident exclusive users to 0.58 (95% CI 0.34, 1.01) in all predominant users. Cancer risk increased with exposure to insulin or sulfonylureas in these patients. Adjusted HRs for death or cancer associated with insulin glargine compared with human insulin ranged from 0.58 (95% CI 0.32, 1.06) to 0.56 (95% CI 0.36, 0.87).Conclusions/interpretationThere was no excess risk of cancer in type 2 diabetic patients on insulin glargine alone compared with those on human insulin alone. The overall risk of death or cancer in patients on insulin glargine was about half that of patients on human insulin, thereby excluding a competitive risk bias.

Risk of Breast Cancer by Individual Insulin Use: An International Multicenter Study

“…The first study to suggest a potential risk of glargine versus human insulin found an OR of 1.31 (95% CI 1.20-1.42) for breast cancer in high-dose users only (.50 UI) while only controlling for a limited number of factors (3). A study from the (18). The large mortality deficit between the two populations might reflect a lack of comparability between populations.…”

Benzodiazepines and risk of death: Results from two large cohort studies in France and UK

“…The EGB has already been used for pharmacoepidemiologic research (Blin, Lassalle et al 2012;Dupouy, Fournier et al 2013;Gallini, Andrieu et al 2013). It includes salaried workers, agricultural workers and farmers, self-employed individuals, retired persons and patients with universal coverage (low income beneficiaries) (Tuppin, de Roquefeuil et al 2010).…”

Antidiabetic Medications and the Risk of Colorectal Cancer in Patients with Diabetes Mellitus: A Systematic Review and Meta-analysis

“…There were four Taiwanese studies from the same cohort (15,34,43,44), and hence, only one report was included in the main analysis (34). There were three studies that compared the association between insulin glargine (as compared with nonglargine insulin) and the risk of cancer, and these were excluded from analysis (45)(46)(47).…”