Cancer specific mortality in insulin-treated type 2 diabetes patients.
AIMS: To test the hypothesis that cumulative exposure to insulin and long-acting insulin analogs might be associated with cancer mortality in diabetes patients. METHODS: All consecutive diabetes patients aged over 40 years, residing in a major urban area were screened at their first diabetes outpati...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3965531?pdf=render |
| _version_ | 1811210826126721024 |
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| author | Sorin Ioacara Cristian Guja Constantin Ionescu-Tirgoviste Simona Fica Michael Roden |
| author_facet | Sorin Ioacara Cristian Guja Constantin Ionescu-Tirgoviste Simona Fica Michael Roden |
| author_sort | Sorin Ioacara |
| collection | DOAJ |
| description | AIMS: To test the hypothesis that cumulative exposure to insulin and long-acting insulin analogs might be associated with cancer mortality in diabetes patients. METHODS: All consecutive diabetes patients aged over 40 years, residing in a major urban area were screened at their first diabetes outpatient visit between 01/01/2001-12/31/2008 (n = 79869). Exclusion criteria were insulin treatment at screening, no insulin treatment until 12/31/2008, less than 6 months of glucose-lowering treatment alone before insulin initiation, insulin prescription before glargine became available, age <40/≥ 80 years at first insulin prescription, and <6 months of insulin exposure. A total 4990 subjects were followed-up for death based on death certificate, until 12/31/2011. Adjusted time-dependent competing risk regression analysis, with daily updates of treatment modalities was performed. Results are expressed for every 10,000 IU of cumulative dose or one year of cumulative time exposure to insulin. RESULTS: Mean baseline age was 62 ± 9 years, and follow-up 4.7 ± 1.9 years. Glargine cumulative dose was associated with lower cancer mortality risk (subhazard ratio, SHR: 0.94 (95%CI 0.89-0.99, p = 0.033)). Cumulative exposure limited to that attained one year prior to death revealed lower SHRs for cumulative time (0.94 (95%CI 0.89-0.99, p = 0.018)) and cumulative dose of glargine (0.92 (95%CI 0.86-0.98, p = 0.014)). Glargine cumulative time and cumulative dose were significant predictors for lower pancreatic and breast cancer mortality, but not for deaths from lung, colorectal, female genital, liver, and urinary tract cancer. No increased hazards were found for any other subtypes of insulins. CONCLUSIONS: The cumulative dose exposure to insulin glargine was associated with a lower risk of cancer mortality in general, and of breast and pancreatic cancer in particular. This effect remained even after additional "fixed" cohort or propensity score analyses. |
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| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T05:01:33Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-9ba01bf85c7b424591ca1d137db9e66f2022-12-22T03:46:58ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0193e9313210.1371/journal.pone.0093132Cancer specific mortality in insulin-treated type 2 diabetes patients.Sorin IoacaraCristian GujaConstantin Ionescu-TirgovisteSimona FicaMichael RodenAIMS: To test the hypothesis that cumulative exposure to insulin and long-acting insulin analogs might be associated with cancer mortality in diabetes patients. METHODS: All consecutive diabetes patients aged over 40 years, residing in a major urban area were screened at their first diabetes outpatient visit between 01/01/2001-12/31/2008 (n = 79869). Exclusion criteria were insulin treatment at screening, no insulin treatment until 12/31/2008, less than 6 months of glucose-lowering treatment alone before insulin initiation, insulin prescription before glargine became available, age <40/≥ 80 years at first insulin prescription, and <6 months of insulin exposure. A total 4990 subjects were followed-up for death based on death certificate, until 12/31/2011. Adjusted time-dependent competing risk regression analysis, with daily updates of treatment modalities was performed. Results are expressed for every 10,000 IU of cumulative dose or one year of cumulative time exposure to insulin. RESULTS: Mean baseline age was 62 ± 9 years, and follow-up 4.7 ± 1.9 years. Glargine cumulative dose was associated with lower cancer mortality risk (subhazard ratio, SHR: 0.94 (95%CI 0.89-0.99, p = 0.033)). Cumulative exposure limited to that attained one year prior to death revealed lower SHRs for cumulative time (0.94 (95%CI 0.89-0.99, p = 0.018)) and cumulative dose of glargine (0.92 (95%CI 0.86-0.98, p = 0.014)). Glargine cumulative time and cumulative dose were significant predictors for lower pancreatic and breast cancer mortality, but not for deaths from lung, colorectal, female genital, liver, and urinary tract cancer. No increased hazards were found for any other subtypes of insulins. CONCLUSIONS: The cumulative dose exposure to insulin glargine was associated with a lower risk of cancer mortality in general, and of breast and pancreatic cancer in particular. This effect remained even after additional "fixed" cohort or propensity score analyses.http://europepmc.org/articles/PMC3965531?pdf=render |
| spellingShingle | Sorin Ioacara Cristian Guja Constantin Ionescu-Tirgoviste Simona Fica Michael Roden Cancer specific mortality in insulin-treated type 2 diabetes patients. PLoS ONE |
| title | Cancer specific mortality in insulin-treated type 2 diabetes patients. |
| title_full | Cancer specific mortality in insulin-treated type 2 diabetes patients. |
| title_fullStr | Cancer specific mortality in insulin-treated type 2 diabetes patients. |
| title_full_unstemmed | Cancer specific mortality in insulin-treated type 2 diabetes patients. |
| title_short | Cancer specific mortality in insulin-treated type 2 diabetes patients. |
| title_sort | cancer specific mortality in insulin treated type 2 diabetes patients |
| url | http://europepmc.org/articles/PMC3965531?pdf=render |
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