DOSES OF INSULIN AND ITS ANALOGUES AND CANCER OCCURRENCE IN INSULIN-TREATED TYPE 2 DIABETIC PATIENTS
- Edoardo Mannucci, MD ()1,
- Matteo Monami, MD, PhD ()2,
- Daniela Balzi, MD3,
- Barbara Cresci, MD4,
- Laura Pala, MD, PhD4,
- Cecilia Melani3,
- Caterina Lamanna, MD1,
- Ilaria Bracali, MD2,
- Michela Bigiarini, MD4,
- Alessandro Barchielli, MD3,
- Niccolò Marchionni, MD2 and
- Carlo Maria Rotella, MD4
- 1Diabetes Agency, Careggi Teaching Hospital, Florence, Italy
- 2Section of Geriatric Cardiology and Medicine, Department of Cardiovascular Medicine, University of Florence and Careggi Teaching Hospital, Florence, Italy
- 3Epidemiology Unit, Local Health Unit 10, Florence, Italy
- 4Section of Endocrinology, Department of Clinical Pathophysiology, University of Florence and Careggi Teaching Hospital, Florence, Italy
Objective: Recent epidemiological studies suggested that some insulin analogues could be associated with increased risk of cancer. The present study is aimed at assessing the long-term association of different insulin analogues with cancer incidence.
Research Design and Methods: A nested case-control study dataset was generated from the cohort-study dataset (n=1,340 insulin-treated diabetic outpatients) by sampling controls from the risk sets. For each case, the controls (up to five) were chosen randomly from those members of the cohort who are at risk for the same follow-up time of the case. Five-year age-classes, sex, and BMI-classes (18.5;18.5-24.9;25-29.9;>=30) were considered as additional categorical matching variables.
Results: During a median follow-up of 75.9 [interquartile range 27.4;133.7] months, 112 cases of incident cancer were compared with 370 matched controls . A significantly higher mean daily dose of glargine was observed in cases than in controls (0.24 [0.10;0.39] vs. 0.16 [0.12;0.24] IU/day•kg, p=0.036). Incident cancer was associated with a dose of glargine ≥0.3 IU/kg•day even after adjusting for Charlson comorbidity score, other types of insulin administration, and metformin exposure (OR 5.43, 95%CI [2.18;13.53]; p<0.001). No association between incident cancer and insulin doses was found for human insulin or other analogues.
Conclusions: The possibility of association between cancer and higher glargine doses suggests that dosages should always be considered when assessing the possible association of insulin and its analogues with cancer.
- Received March 11, 2010.
- Accepted June 8, 2010.
- Copyright © American Diabetes Association