Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada.
Diabetologia. 2011 Jan;54(1):25-31. doi: 10.1007/s00125-010-1933-3. Epub 2010 Oct 20.
AIMS/HYPOTHESIS: The purpose of this study was to explore the relationship between hyperglycaemia in type 2 diabetes and risk of cancer incidence or cancer mortality. We were interested to determine if data from major randomised controlled trials would support a hypothesis that improving glycaemic control may reduce the risk of cancer outcomes.
We included major randomised controlled trials conducted with an overall aim of intensified glycaemic control in type 2 diabetes. We abstracted data from published papers and supplemental material and conducted separate meta-analyses of cancer mortality and cancer incidence.
Four trials reported cancer mortality for the intensive (222 events in 53,892 person-years) and standard control (155 events in 38,743 person-years) arms (UK Prospective Diabetes Study [UKPDS] 33, UKPDS 34, Action to Control Cardiovascular Risk in Diabetes [ACCORD] and Veterans Affairs Diabetes Trial [VADT]); the summary risk ratio for cancer mortality was 1.00 (95% CI 0.81-1.24; I² = 0%). Excluding the UKPDS metformin trial resulted in a pooled risk estimate of 1.03 (95% CI 0.83-1.29; I² = 0%). Three trials reported cancer incidence for the study arms (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation [ADVANCE], PROspective pioglitAzone Clinical Trial In macroVascular Events [PROactive], Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes [RECORD]) with 357 events in 47,974 person-years with improved glycaemic control and 380 events in 45,009 person-years in the control arms; the pooled risk ratio for cancer incidence was 0.91 (95% CI 0.79-1.05; I² = 0%).
CONCLUSIONS/INTERPRETATION: Data from large randomised controlled trials of intensified glycaemic control suggest that cancer risk is not reduced by improving glycaemic control in type 2 diabetes. These data therefore do not support the hypothesis that hyperglycaemia is causally linked to increased cancer risk.
目的/假设：本研究旨在探讨 2 型糖尿病患者的高血糖与癌症发病率或癌症死亡率之间的关系。我们感兴趣的是确定主要随机对照试验的数据是否支持这样一种假设，即改善血糖控制可能降低癌症结局的风险。
我们纳入了以 2 型糖尿病强化血糖控制为总体目标的主要随机对照试验。我们从已发表的论文和补充材料中提取数据，并对癌症死亡率和癌症发病率进行单独的荟萃分析。
四项试验报告了强化治疗组（222 例事件，53892 人年）和标准对照组（155 例事件，38743 人年）的癌症死亡率（英国前瞻性糖尿病研究[UKPDS]33、UKPDS34、心血管风险控制行动糖尿病[ACCORD]和退伍军人事务部糖尿病试验[VADT]）；癌症死亡率的汇总风险比为 1.00（95%可信区间 0.81-1.24；I²=0%）。排除 UKPDS 二甲双胍试验后，合并风险估计值为 1.03（95%可信区间 0.83-1.29；I²=0%）。三项试验报告了研究组的癌症发病率（糖尿病和血管疾病行动：培哚普利和二甲双胍控释剂对照评估[ADVANCE]、吡格列酮前瞻性临床试验治疗大血管事件[PROactive]、罗格列酮评估心脏结局和糖尿病血糖调节[RECORD]），其中强化血糖控制组有 357 例事件，47974 人年，对照组有 380 例事件，45009 人年；癌症发病率的汇总风险比为 0.91（95%可信区间 0.79-1.05；I²=0%）。
结论/解释：强化血糖控制的大型随机对照试验数据表明，改善 2 型糖尿病患者的血糖控制并不能降低癌症风险。因此，这些数据不支持高血糖与癌症风险增加有因果关系的假设。
