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

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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

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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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Authors: Bowker, S. L., Majumdar, S. R., Veugelers, P., & Johnson, J. A.
Affiliations: University of Alberta (CA)
ORCID: Majumdar, Sumit R.
Veugelers, Paul
Johnson, Jeffrey A.
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: bronze
doi.org
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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Increased Cancer-Related Mortality for Patients With Type 2 Diabetes Who Use Sulfonylureas or Insulin

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