Monami M, Lamanna C, Pala L, Bardini G, Cresci B, Francesconi P, Balzi D, Marchionni N, Rotella C M, Mannucci E
Department of Critical Care Medicine and Surgery, Unit of Geriatrics, University of Florence, Florence, Italy.
Exp Clin Endocrinol Diabetes. 2008 Mar;116(3):184-9. doi: 10.1055/s-2007-992157. Epub 2008 Feb 14.
Recent evidence suggests that some hypoglycemic treatments could affect the incidence of malignancies. This study was aimed at the assessment of cancer-related mortality in type 2 diabetic patients treated with different hypoglycemic drugs.
A retrospective observational cohort study was performed on a consecutive series of 3002 type 2 diabetic outpatients. Cancer-related death was identified through the City Registry Office. For patients visited for the first time after January 1 (st), 2000, information on incidence of cancer was also available.
During a mean follow-up of 4.3+/-2.5 years, 87 cases of cancer-related death were recorded, with a yearly incidence rate of 0.70%. Patients receiving secretagogues showed a significantly higher mortality than the rest of the sample (unadjusted OR [95%CI] 1.76 [1.15-2.69], p=0.009), which was maintained after adjustment for confounders (HR 2.29 [1.21-4.02], p=0.003). Conversely, no significant association of cancer-related mortality was observed with insulin sensitizers or exogenous insulin. In comparison with patients receiving no hypoglycemic treatment, those on secretagogue or insulin monotherapy showed a higher cancer-related mortality (HR 2.25 [1.10-4.78], p=0.034 and HR 2.11 [1.01-4.50], p=0.048, respectively). The effect of treatments on incidence of malignancies was similar to that observed on cancer-related death.
Insulin secretagogues and, to a lesser extent, exogenous insulin, appear to be associated with increased mortality for cancer, even after adjustment for multiple confounders. This issue deserves further investigation through epidemiological studies on larger samples of patients.
近期证据表明，某些降糖治疗可能会影响恶性肿瘤的发生率。本研究旨在评估接受不同降糖药物治疗的2型糖尿病患者的癌症相关死亡率。
对连续3002例2型糖尿病门诊患者进行回顾性观察队列研究。通过城市登记处确定癌症相关死亡情况。对于2000年1月1日之后首次就诊的患者，还可获得癌症发病率信息。
在平均4.3±2.5年的随访期间，记录到87例癌症相关死亡，年发病率为0.70%。接受促分泌剂治疗的患者死亡率显著高于其余样本（未调整的比值比[95%置信区间]为1.76[1.15 - 2.69]，p = 0.009），在对混杂因素进行调整后该差异依然存在（风险比为2.29[1.21 - 4.02]，p = 0.003）。相反，未观察到胰岛素增敏剂或外源性胰岛素与癌症相关死亡率之间存在显著关联。与未接受降糖治疗的患者相比，接受促分泌剂或胰岛素单药治疗的患者癌症相关死亡率更高（风险比分别为2.25[1.10 - 4.78]，p = 0.034和2.11[1.01 - 4.50]，p = 0.048）。治疗对恶性肿瘤发生率的影响与对癌症相关死亡的影响相似。
即使在对多个混杂因素进行调整后，胰岛素促分泌剂以及在较小程度上外源性胰岛素，似乎都与癌症死亡率增加有关。这个问题值得通过对更大样本患者的流行病学研究作进一步调查。
