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Metformin Associated With Lower Cancer Mortality in Type 2 Diabetes
Open accessAbstract
OBJECTIVE: Several studies have suggested an association between specific diabetes treatment and cancer mortality. We studied the association between metformin use and cancer mortality in a prospectively followed cohort. RESEARCH DESIGN AND METHODS: In 1998 and 1999, 1,353 patients with type 2 diabetes were enrolled in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study in the Netherlands. Vital status was assessed in January 2009. Cancer mortality rate was evaluated using standardized mortality ratios (SMRs), and the association between metformin use and cancer mortality was evaluated with a Cox proportional hazards model, taking possible confounders into account. RESULTS: Median follow-up time was 9.6 years, average age at baseline was 68 years, and average A1C was 7.5%. Of the patients, 570 died, of which 122 died of malignancies. The SMR for cancer mortality was 1.47 (95% CI 1.22–1.76). In patients taking metformin compared with patients not taking metformin at baseline, the adjusted hazard ratio (HR) for cancer mortality was 0.43 (95% CI 0.23–0.80), and the HR with every increase of 1 g of metformin was 0.58 (95% CI 0.36–0.93). CONCLUSIONS: In general, patients with type 2 diabetes are at increased risk for cancer mortality. In our group, metformin use was associated with lower cancer mortality compared with nonuse of metformin. Although the design cannot provide a conclusion about causality, our results suggest a protective effect of metformin on cancer mortality.
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“Several epidemiologic studies have shown that metformin use is associated with reduced cancer incidence and mortality (Landman et al., 2010; Lee et al., 2011; Libby et al., 2009; Monami et al., 2011; Tseng, 2012).”
From Metformin as a tool to target aging (2016) · cites this paper as Landman et al., 2010
In the citing paper
“The reduced risk of cancer and cancer mortality observed in these studies has been consistently in the range of 25% to 30% [135-139,145-147].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [138]
In the citing paper
“A prospective study (median follow-up time of 9.6 years) found that metformin use at baseline was associated with lower cancer-related mortality and that this association appeared to be dose dependent [138].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [138]
In the citing paper
“Metformin use is associated with lower cancer-related mortality.”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [138]
In the citing paper
“Patients with type 2 diabetes who are prescribed metformin had a lower risk of cancer compared to patients who did not take it.”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [138]
In the citing paper
“When compared to those on other treatments, metformin users had a lower risk of cancer. A dose-relationship has been reported [138,144,145].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [138]
In the citing paper
“Results of a growing number of observational human studies suggest that treatment with metformin (relative to other glucose-lowering therapies) is associated with reduced risk of cancer (89–93) or cancer mortality (94).”
From Diabetes and Cancer (2010) · cites this paper as [94]
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Metadata
- Authors
- Landman, G. W. D., Kleefstra, N., van Hateren, K. J. J., Groenier, K. H., Gans, R. O. B., & Bilo, H. J. G.
- Affiliations
- Isala (NL)
- Diabetes Centre, Isala Clinics, Zwolle, the Netherlands;
- University Medical Center Groningen (NL)
- Corresponding author
- Landman, Gijs W.D.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-11-16
- Volume
- 33
- Issue
- 2
- Pages
- 322-326
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2809274
- OpenAlex
- W2058725063
- Cited by
- 502
- References
- 20
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 11 · 2023: 17 · 2022: 28 · 2021: 24 · 2020: 31 · 2019: 23 · 2018: 28 · 2017: 30 · 2016: 25 · 2015: 39 · 2014: 41 · 2013: 54 · 2012: 48
- FWCI
- 18.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Keywords
- metformin, cancer mortality, type 2 diabetes, diabetes drugs, cancer risk, standardized mortality ratio
- MeSH terms
- Aged, Blood Pressure, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Glycated Hemoglobin, Humans, Hypertension, Hypoglycemic Agents, Insulin, Male, Metformin, Middle Aged, Neoplasms, Netherlands, Prospective Studies, Risk Factors, Smoking, Cohort Studies, Body Mass Index
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