Lu Chieh-Hua, Chung Chi-Hsiang, Kuo Feng-Chih, Chen Kuan-Chan, Chang Chia-Hao, Kuo Chih-Chun, Lee Chien-Hsing, Su Sheng-Chiang, Liu Jhih-Syuan, Lin Fu-Huang, Tsao Chang-Huei, Hsieh Po-Shiuan, Hung Yi-Jen, Hsieh Chang-Hsun, Chien Wu-Chien
Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan.
Department of Medical Research, National Defense Medical Center, Taipei 11490, Taiwan.
J Clin Med. 2020 Sep 2;9(9):2839. doi: 10.3390/jcm9092839.
Patients with diabetes are at increased risk of cancer development and osteoporosis. Metformin is an effective agent for diabetes management. Epidemiological studies have identified an association between metformin use and cancer prevention. This article outlines the potential for metformin to attenuate the rate of osteoporosis in diabetic patients with carcinoma in situ (CIS). From the National Health Insurance Research Database of Taiwan, 7827 patients with diabetes with CIS who were receiving metformin therapy were selected, along with 23,481 patients as 1:3 sex-, age- and index year-matched controls, who were not receiving metformin therapy. A Cox proportional hazard analysis was used to compare the rate of osteoporosis during an average of 15-year follow-up. Of the subjects who were enrolled, 801 (2.56%) had osteoporosis, including 168 from the metformin group (2.15%) and 633 from the without metformin group (2.70%). The metformin group presented a lower rate of osteoporosis at the end of follow-up ( = 0.009). The Cox proportional hazard regression analysis revealed a lower rate of osteoporosis for the metformin group (adjusted hazard ratio of 0.820; 95% confidence interval = 0.691-0.972, = 0.022). Diabetic patients with CIS under metformin therapy presented lower osteoporosis rate than those who were not receiving metformin therapy.
糖尿病患者患癌症和骨质疏松症的风险增加。二甲双胍是治疗糖尿病的有效药物。流行病学研究已确定二甲双胍的使用与癌症预防之间存在关联。本文概述了二甲双胍降低原位癌（CIS）糖尿病患者骨质疏松症发病率的可能性。从台湾国民健康保险研究数据库中，选取了7827例接受二甲双胍治疗的CIS糖尿病患者，以及23481例作为1:3性别、年龄和索引年份匹配的对照患者，这些对照患者未接受二甲双胍治疗。采用Cox比例风险分析比较平均15年随访期间的骨质疏松症发病率。在纳入的受试者中，801例（2.56%）患有骨质疏松症，其中二甲双胍组168例（2.15%），未使用二甲双胍组633例（2.70%）。随访结束时，二甲双胍组的骨质疏松症发病率较低（P = 0.009）。Cox比例风险回归分析显示，二甲双胍组的骨质疏松症发病率较低（调整后的风险比为0.820；95%置信区间 = 0.691 - 0.972，P = 0.022）。接受二甲双胍治疗的CIS糖尿病患者的骨质疏松症发病率低于未接受二甲双胍治疗的患者。
