Ye Jing-Hong, Qian Meng-Hua, Shi Li-Zheng, Ye Lu
Department of Health Economics, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China.
Shanghai Hongkou Center for Disease Control and Prevention, Shanghai, China.
Diabetes Ther. 2019 Feb;10(1):245-258. doi: 10.1007/s13300-018-0557-3. Epub 2019 Jan 8.
Previous studies have shown that patients with type 2 diabetes mellitus have an increased risk of cancer. The use of antidiabetic medication (ADM) may play an important role in the cancer development. The relationship between oral ADM and cancer incidence has not been investigated in type 2 diabetes mellitus patients in mainland China yet.
A community-based diabetes cohort was extracted from the Shanghai Community Diabetes Management System database, which is a patient registry from general practices. The cohort included 2353 newly onset type 2 diabetes mellitus patients from 2006 to 2010 aged 35 years or more. Patients were grouped into nonusers of antidiabetic medication (n = 722), metformin monotherapy (n = 374), sulfonylurea monotherapy (n = 653), metformin and sulfonylurea combination therapy (n = 302), and other medication therapies (n = 302) on the basis of initial treatment type at registry entry. Cancer incidence was identified from the Shanghai Cancer Registry Organization. Comparisons between monotherapy and nonuser of medication were conducted using Cox proportional hazards models.
A total of 94 cancer cases were identified during 5 years median follow-up. Compared with nonusers, sulfonylurea monotherapy was associated with significantly lower risk of cancer [adjusted HR = 0.50 (95% CI 0.29-0.85)] whereas risk was 49% lower with metformin monotherapy [adjusted HR = 0.51 (95% CI 0.27-0.99)].
The real-world evidence suggested that the use of metformin or sulfonylurea was associated with lower risk of cancer incidence in a cohort of newly onset type 2 diabetes mellitus patients.
先前的研究表明，2型糖尿病患者患癌风险增加。抗糖尿病药物（ADM）的使用可能在癌症发展中起重要作用。中国大陆2型糖尿病患者中口服ADM与癌症发病率之间的关系尚未得到研究。
从上海社区糖尿病管理系统数据库中提取一个基于社区的糖尿病队列，该数据库是一个来自全科医疗的患者登记库。该队列包括2006年至2010年35岁及以上的2353例新诊断的2型糖尿病患者。根据登记时的初始治疗类型，将患者分为未使用抗糖尿病药物组（n = 722）、二甲双胍单药治疗组（n = 374）、磺脲类单药治疗组（n = 653）、二甲双胍与磺脲类联合治疗组（n = 302）和其他药物治疗组（n = 302）。癌症发病率通过上海癌症登记机构确定。使用Cox比例风险模型对单药治疗组与未使用药物组进行比较。
在中位随访5年期间共确定了94例癌症病例。与未使用者相比，磺脲类单药治疗与显著较低的癌症风险相关[调整后风险比（HR）= 0.50（95%置信区间0.29 - 0.85）]，而二甲双胍单药治疗的风险降低49%[调整后HR = 0.51（95%置信区间0.27 - 0.99）]。
真实世界证据表明，在一组新诊断的2型糖尿病患者中，使用二甲双胍或磺脲类药物与较低的癌症发病率风险相关。
