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Cited by 933Metabolism, Diabetes, and CancerDiabetes Treatment and ManagementDiabetes Management and Research

Increased Cancer-Related Mortality for Patients With Type 2 Diabetes Who Use Sulfonylureas or Insulin

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Bowker, Samantha L., Majumdar, Sumit R., Veugelers, Paul, Johnson, Jeffrey A.·2006·Diabetes Care
DOI 10.2337/diacare.29.02.06.dc05-1558
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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.

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  • Patients with type 2 diabetes who are prescribed metformin had a lower risk of cancer compared to patients who did not take it.

    “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 [147]

  • The reduced risk of cancer and cancer mortality observed in studies of metformin users has been consistently in the range of 25% to 30%.

    “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 [147]

  • 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.

    “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.”

    From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [147]

  • Treatment with metformin relative to other glucose-lowering therapies is associated with reduced risk of cancer or cancer mortality in observational human studies.

    “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 [90]

  • A small number of observational studies found a higher risk of cancer or cancer death among individuals with diabetes treated with sulfonylureas compared with those treated with metformin or other diabetes medications.

    “A small number of observational studies found a higher risk of cancer or cancer death among individuals with diabetes treated with sulfonylureas compared with those treated with metformin or other diabetes medications (90–92,110).”

    From Diabetes and Cancer (2010) · cites this paper as [90]

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Authors
Bowker, S. L., Majumdar, S. R., Veugelers, P., & Johnson, J. A.
Affiliations
University of Alberta (CA)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2006-02-01
Volume
29
Issue
2
Pages
254-258
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.29.02.06.dc05-1558
OpenAlex
W2156370651
Cited by
933
References
37
Citations by year
2026: 9 · 2025: 13 · 2024: 28 · 2023: 32 · 2022: 26 · 2021: 25 · 2020: 33 · 2019: 37 · 2018: 33 · 2017: 45 · 2016: 43 · 2015: 52 · 2014: 55 · 2013: 96 · 2012: 93
FWCI
16.30
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
type 2 diabetes, cancer mortality, sulfonylureas, insulin therapy, metformin, antidiabetic drugs, cancer risk
MeSH terms
Aged, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Insulin, Male, Metformin, Middle Aged, Neoplasms, Retrospective Studies, Risk Factors, Saskatchewan, Severity of Illness Index, Sulfonylurea Compounds, Cohort Studies, Comorbidity, Multivariate Analysis, Proportional Hazards Models

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