Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
Diabetologia. 2010 May;53(5):802-8. doi: 10.1007/s00125-010-1675-2. Epub 2010 Feb 23.
Four reports in Diabetologia presented data on the association between hypoglycaemic agents and the risk of cancer. One study showed a higher risk of cancer overall in subjects with diabetes receiving insulin or sulfonylureas than in those on metformin. In another study, the risk of cancer overall increased with dose for any type of insulin and, among high doses, insulin glargine (A21Gly,B31Arg,B32Arg human insulin)-only users had a higher risk than subjects on human insulin. In two studies, users of insulin glargine alone had a higher risk of breast cancer than those on other insulins, a third study found no association. Whether these associations are causal or at least partially explained by chance or biases such as confounding, reverse causation, selection or detection biases is arguable. Current epidemiological evidence is insufficient to confirm a carcinogenic effect of specific insulins on specific cancers. However, the potential dose effect of insulin overall, and insulin glargine in particular, on colon and breast cancer deserves further attention.
《糖尿病学》杂志的 4 篇报告介绍了低血糖药物与癌症风险之间的关联。一项研究表明，接受胰岛素或磺酰脲类药物治疗的糖尿病患者的总体癌症风险高于接受二甲双胍治疗的患者。另一项研究显示，任何类型的胰岛素的剂量越大，总体癌症风险越高，而在高剂量下，甘精胰岛素（A21Gly、B31Arg、B32Arg 人胰岛素）使用者的风险高于人胰岛素使用者。在两项研究中，单独使用甘精胰岛素的患者患乳腺癌的风险高于其他胰岛素使用者，第三项研究则未发现相关性。这些关联是由因果关系引起的，还是至少部分由机会或混杂、反向因果、选择或检测偏倚等因素解释的，这是有争议的。目前的流行病学证据还不足以证实特定胰岛素对特定癌症具有致癌作用。然而，胰岛素（尤其是甘精胰岛素）对结肠癌和乳腺癌的潜在剂量效应值得进一步关注。
