Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50134, Florence, Italy.
Acta Diabetol. 2009 Dec;46(4):279-84. doi: 10.1007/s00592-008-0083-2. Epub 2008 Dec 10.
This study was aimed at the assessment of incidence of malignancies in type 2 diabetic patients treated with different sulphonylureas. A matched case-control study was performed. Cases were 195 diabetic patients aged 69.0 +/- 9.2 years who had an incident malignancy. Controls were 195 diabetic patients, unaffected by cancer, who were matched with the corresponding case for age, sex, duration of diabetes, BMI, HbA1(c), comorbidity, smoking and alcohol abuse. Exposure to hypoglycaemic drugs during the 10 years preceding the event (or matching index date) was assessed. After adjusting for concomitant therapies, exposure to metformin and gliclazide for more than 36 months was associated with a significant reduction in the risk of cancer (adj. ORs with 95% CI: 0.28 (0.13-0.57), p < 0.001, and 0.40 (0.21-0.57), p = 0.004, respectively). Conversely, use of glibenclamide for at least 36 months was associated with increased incidence of malignancies (adj. OR 2.62 (1.26-5.42); p = 0.009). Treatment with insulin, thiazolidinediones, or acarbose, was not associated with significant differences in the incidence of cancer. Long-term treatments with individual sulphonylureas could have differential effects on the risk of cancer. In particular, the possible protective effect of gliclazide, as well as the risk associated with glibenclamide, deserves further investigation.
本研究旨在评估使用不同磺酰脲类药物治疗的 2 型糖尿病患者的恶性肿瘤发病率。进行了一项匹配病例对照研究。病例为 195 名年龄为 69.0±9.2 岁的新发恶性肿瘤的 2 型糖尿病患者。对照组为 195 名未患癌症的糖尿病患者，与相应病例按年龄、性别、糖尿病病程、BMI、HbA1(c)、合并症、吸烟和酗酒情况匹配。评估了事件（或匹配指数日期）前 10 年期间使用降糖药物的情况。在调整伴随治疗后，使用二甲双胍和格列齐特超过 36 个月与癌症风险显著降低相关（调整后的 OR 及其 95%CI：0.28（0.13-0.57），p<0.001 和 0.40（0.21-0.57），p=0.004）。相反，至少使用格列本脲 36 个月与恶性肿瘤发病率增加相关（调整后的 OR 2.62（1.26-5.42）；p=0.009）。使用胰岛素、噻唑烷二酮或阿卡波糖治疗与癌症发病率无显著差异相关。长期使用个别磺酰脲类药物可能对癌症风险有不同的影响。特别是格列齐特的可能保护作用以及与格列本脲相关的风险值得进一步研究。
