Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin
- PMID: 16443869
- DOI: 10.2337/diacare.29.02.06.dc05-1558
Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin
Abstract
Objective: Numerous studies have identified an increased risk of cancer in type 2 diabetes. We explored the association between antidiabetic therapies and cancer-related mortality in patients with type 2 diabetes, postulating that agents that increase insulin levels might promote cancer.
Research design and methods: This was a population-based cohort study using administrative databases from Saskatchewan Health. Cancer-related mortality was compared among inception cohorts of metformin users and sulfonylurea monotherapy users. Multivariate Cox regression was used to estimate the hazard ratio (HR) of cancer-related mortality, after adjusting for age, sex, insulin use, and chronic disease score. All statistical tests were two-sided.
Results: We identified 10,309 new users of metformin or sulfonylureas with an average follow-up of 5.4 +/- 1.9 years (means +/- SD). The mean age for the cohort was 63.4 +/- 13.3 years, and 55% were men. Cancer mortality over follow-up was 4.9% (162 of 3,340) for sulfonylurea monotherapy users, 3.5% (245 of 6,969) for metformin users, and 5.8% (84 of 1,443) for subjects who used insulin. After multivariate adjustment, the sulfonylurea cohort had greater cancer-related mortality compared with the metformin cohort (adjusted HR 1.3 [95% CI 1.1-1.6]; P = 0.012). Insulin use was associated with an adjusted HR of cancer-related mortality of 1.9 (95% CI 1.5-2.4; P < 0.0001).
Conclusions: Patients with type 2 diabetes exposed to sulfonylureas and exogenous insulin had a significantly increased risk of cancer-related mortality compared with patients exposed to metformin. It is uncertain whether this increased risk is related to a deleterious effect of sulfonylurea and insulin or a protective effect of metformin or due to some unmeasured effect related to both choice of therapy and cancer risk.
Comment in
-
Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin: Response to Bowker et Al.Diabetes Care. 2006 Aug;29(8):1989-90. doi: 10.2337/dc06-0874. Diabetes Care. 2006. PMID: 16873827 No abstract available.
Similar articles
-
Review of the Case Reports on Metformin, Sulfonylurea, and Thiazolidinedione Therapies in Type 2 Diabetes Mellitus Patients.Med Sci (Basel). 2023 Aug 15;11(3):50. doi: 10.3390/medsci11030050. Med Sci (Basel). 2023. PMID: 37606429 Free PMC article. Review.
-
Are sulfonylurea and insulin therapies associated with a larger risk of cancer than metformin therapy? A retrospective database analysis.Diabetes Care. 2015 Jan;38(1):59-65. doi: 10.2337/dc14-0977. Epub 2014 Oct 21. Diabetes Care. 2015. PMID: 25336750
-
Metformin and sulfonylureas in relation to cancer risk in type II diabetes patients: a meta-analysis using primary data of published studies.Metabolism. 2013 Jul;62(7):922-34. doi: 10.1016/j.metabol.2013.01.014. Epub 2013 Feb 16. Metabolism. 2013. PMID: 23419783 Review.
-
Glucose-lowering agents and cancer mortality rates in type 2 diabetes: assessing effects of time-varying exposure.Diabetologia. 2010 Aug;53(8):1631-7. doi: 10.1007/s00125-010-1750-8. Epub 2010 Apr 21. Diabetologia. 2010. PMID: 20407744
-
Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes.Diabetes Care. 2002 Dec;25(12):2244-8. doi: 10.2337/diacare.25.12.2244. Diabetes Care. 2002. PMID: 12453968
Cited by
-
AMPK as a mediator of tissue preservation: time for a shift in dogma?Nat Rev Endocrinol. 2024 May 17. doi: 10.1038/s41574-024-00992-y. Online ahead of print. Nat Rev Endocrinol. 2024. PMID: 38760482 Review.
-
Biguanides and glucagon like peptide 1 receptor agonists in the amelioration of post liver transplant weight gain; a scoping review of the mechanism of action, safety and efficacy.Gastroenterol Hepatol Bed Bench. 2024;17(1):17-27. doi: 10.22037/ghfbb.v17i1.2899. Gastroenterol Hepatol Bed Bench. 2024. PMID: 38737926 Free PMC article. Review.
-
Metformin: A Dual-Role Player in Cancer Treatment and Prevention.Int J Mol Sci. 2024 Apr 6;25(7):4083. doi: 10.3390/ijms25074083. Int J Mol Sci. 2024. PMID: 38612893 Free PMC article. Review.
-
Metformin and Breast Cancer: Current Findings and Future Perspectives from Preclinical and Clinical Studies.Pharmaceuticals (Basel). 2024 Mar 19;17(3):396. doi: 10.3390/ph17030396. Pharmaceuticals (Basel). 2024. PMID: 38543182 Free PMC article. Review.
-
Cancer biology in diabetes update: Focusing on antidiabetic drugs.J Diabetes Investig. 2024 May;15(5):525-540. doi: 10.1111/jdi.14152. Epub 2024 Mar 8. J Diabetes Investig. 2024. PMID: 38456597 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical