Abstract
AimThe aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.MethodsWe recruited 8,774 insulin-naïve diabetes patients from the Shanghai Diabetes Registry (SDR). The follow-up rate was 85.4%. All subjects were divided into the insulin use cohort (n = 3,639) and the non-insulin use cohort (n = 5,135). The primary outcome was the first diagnosis of any cancer. The secondary outcome was all-cause mortality. Cox proportional hazards model was used to estimate the relative risk (RR) of cancer and mortality.ResultsWe observed 98 cancer events in the insulin use cohort and 170 in the non-insulin use cohort. Cancer incidence rates were 78.6 and 74.3 per 10,000 patients per year in the insulin users and the non-insulin users, respectively. No significant difference in cancer risk was observed between the two cohorts (adjusted RR = 1.20, 95% CI 0.89–1.62, P = 0.228). Regarding site-specific cancers, only the risk of liver cancer was significantly higher in the insulin users compared to that in the non-insulin users (adjusted RR = 2.84, 95% CI 1.12–7.17, P = 0.028). The risks of overall mortality (adjusted RR = 1.89, 95% CI 1.47–2.43, P<0.0001) and death from cancer (adjusted RR = 2.16, 95% CI 1.39–3.35, P = 0.001) were all significantly higher in the insulin users than in the non-insulin users.ConclusionThere was no excess risk of overall cancer in patients with type 2 diabetes who were treated with human insulin. However, a significantly higher risk of liver cancer was found in these patients. Moreover, insulin users showed higher risks of overall and cancer mortality. Considering that individuals treated with insulin were more likely to be advanced diabetic patients, caution should be used in interpreting these results.
Highlights
Diabetes and anti-diabetic therapy were both possibly related to cancer morbidity and mortality
Chang et al reported that insulin glargine did not increase the overall cancer incidence when compared with human insulin in the Taiwanese population [10], and Tseng et al found that insulin use did not increase colon cancer mortality [11]
The primary objective of the present study was to survey the overall and sitespecific cancer risk in Chinese patients with type 2 diabetes who were treated with human insulin
Summary
Diabetes and anti-diabetic therapy were both possibly related to cancer morbidity and mortality. Several cohort studies have strongly suggested that the incidence of some types of cancer and mortality is higher in patients with diabetes, predominantly type 2 diabetes [1]. There is evidence suggests that several hypoglycemic medications are associated with either an increased or a reduced risk of cancer [2]. Insulin is one of the most commonly prescribed medications, and the interest in its role on cancer risk in diabetic patients has increased recently. Studies regarding the relationship between insulin and cancer incidence and mortality in the population from Mainland China are still lacking. The primary objective of the present study was to survey the overall and sitespecific cancer risk in Chinese patients with type 2 diabetes who were treated with human insulin. Our secondary objective was to examine the relationship between insulin use and mortality in patients with type 2 diabetes
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