早期药物治疗和二甲双胍用于预防糖尿病患者癌症的效果：使用扩展 landmark 时间分析的韩国全国样本队列研究。
Effects of early medication treatment and metformin use for cancer prevention in diabetes patients: a nationwide sample cohort study in Korea using extended landmark time analysis.
机构信息
Medical Informatics and health Technology (MIT), Department of Health Care Management, Gachon University, Seongnam, Korea.
Department of Applied Statistics, School of Social Science, Gachon University, Seongnam, Korea.
出版信息
Epidemiol Health. 2021;43:e2021103. doi: 10.4178/epih.e2021103. Epub 2021 Dec 17.
OBJECTIVES
This study investigated the effectiveness of early medication treatment and metformin use for cancer prevention in type 2 diabetes patients.
METHODS
Population-based cohort data were used from the Korean National Health Insurance Service-National Sample Cohort database (KNHIS-NSC) for 2002-2013. Patient-specific medication prescription status was defined by the landmark time (LMT; a fixed time after cohort entry), considering both pre- and post-LMT prescriptions to control methodological biases in observational research. The LMT was set to 2 years. Logistic regression analysis with multivariable adjustment was conducted to analyze cancer incidence by patient-specific medication prescription status.
RESULTS
Only 33.4% of the subjects were prescribed medication early (before the LMT) with compliance. Cancer incidence in individuals with early prescription and compliance was 25% lower (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.67 to 0.84) than in those without. As early-prescribed medications, metformin monotherapy and metformin combination therapy were associated with 34% (OR, 0.66; 95% CI, 0.51 to 0.83) and 25% (OR, 0.75; 95% CI, 0.64 to 0.88) lower cancer risk than non-use, respectively. Patients who were prescribed late (post-LMT) but did not comply with the prescription had a 24% (OR, 1.24; 95% CI, 0.97 to 1.58) higher cancer incidence than non-users. Among patients who started monotherapy early without changes throughout the entire follow-up period, those who started on metformin had a 37% (OR, 0.63; 95% CI, 0.41 to 0.99) lower risk of cancer than non-metformin users.
CONCLUSIONS
Doctors must prescribe antidiabetic medication early, and patient compliance is required, regardless of the prescription time, to prevent cancer. Metformin monotherapy or combination therapy is recommended as an early prescription.
目的
本研究旨在探讨 2 型糖尿病患者早期药物治疗和二甲双胍使用对癌症预防的效果。
方法
本研究使用了韩国国民健康保险服务-国家样本队列数据库（KNHIS-NSC）2002-2013 年的基于人群的队列数据。根据里程碑时间（LMT；队列入组后固定时间）定义患者的特定药物处方状态，同时考虑前后 LMT 处方，以控制观察性研究中的方法学偏倚。LMT 设置为 2 年。采用多变量调整的逻辑回归分析，根据患者特定药物处方状态分析癌症发病率。
结果
仅有 33.4%的患者符合规定提前（LMT 之前）服药，且药物依从性较好。与未提前服药的患者相比，提前服药且药物依从性较好的患者癌症发病率降低 25%（比值比 [OR]，0.75；95%置信区间 [CI]，0.67 至 0.84）。与未使用相比，二甲双胍单药治疗和二甲双胍联合治疗作为早期处方药物，癌症风险分别降低 34%（OR，0.66；95% CI，0.51 至 0.83）和 25%（OR，0.75；95% CI，0.64 至 0.88）。尽管处方时间较晚（LMT 之后），但未遵循处方的患者癌症发病率比未使用者高 24%（OR，1.24；95% CI，0.97 至 1.58）。在整个随访期间未改变单药治疗方案且开始治疗较早的患者中，起始使用二甲双胍的患者癌症风险比未使用二甲双胍的患者低 37%（OR，0.63；95% CI，0.41 至 0.99）。
结论
无论处方时间如何，医生都必须及早开出抗糖尿病药物，并要求患者遵守处方，以预防癌症。建议将二甲双胍单药或联合治疗作为早期处方。
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