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Epidemiology/Health Services Research

Incidence of Bladder Cancer in Patients With Type 2 Diabetes Treated With Metformin or Sulfonylureas

  1. Ronac Mamtani1⇑,
  2. Nick Pfanzelter1,
  3. Kevin Haynes2,
  4. Brian S. Finkelman2,
  5. Xingmei Wang2,
  6. Stephen M. Keefe1,
  7. Naomi B. Haas1,
  8. David J. Vaughn1 and
  9. James D. Lewis2
  1. 1Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
  2. 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
  1. Corresponding author: Ronac Mamtani, ronac.mamtani{at}uphs.upenn.edu.
Diabetes Care 2014 Jul; 37(7): 1910-1917. https://doi.org/10.2337/dc13-1489
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Abstract

OBJECTIVE Previous studies evaluating the effect of metformin on cancer risk have been impacted by time-related biases. To avoid these biases, we examined the incidence of bladder cancer in new users of metformin and sulfonylureas (SUs).

RESEARCH DESIGN AND METHODS This cohort study included 87,600 patients with type 2 diabetes in The Health Improvement Network database. Use of metformin or an SU was treated as a time-dependent variable. Cox regression–generated hazard ratios (HRs) compared metformin use with SU use, adjusted for age, sex, smoking, obesity, and HbA1c level.

RESULTS We identified 196 incident bladder cancers in the metformin cohort and 66 cancers in the SU cohort. Use of metformin was not associated with decreased bladder cancer risk (HR 0.81 [95% CI 0.60–1.09]). This association did not differ by sex (P for interaction = 0.20). We observed no association with duration of metformin relative to SU use (3 to <4 years of use: 0.57 [0.25–1.34]; 4 to <5 years of use: 0.93 [0.30–2.85; ≥5 years of use: 1.18 [0.44–3.19]; P for trend = 0.26).

CONCLUSIONS Use of metformin is not associated with a decreased incidence of bladder cancer. Similar methods should be used to study other cancers that have previously been identified as potentially preventable with metformin.

Footnotes

  • See accompanying article, p. 1786.

  • Received June 24, 2013.
  • Accepted December 24, 2013.
  • © 2014 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Diabetes Care: 37 (7)

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July 2014, 37(7)
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Incidence of Bladder Cancer in Patients With Type 2 Diabetes Treated With Metformin or Sulfonylureas
Ronac Mamtani, Nick Pfanzelter, Kevin Haynes, Brian S. Finkelman, Xingmei Wang, Stephen M. Keefe, Naomi B. Haas, David J. Vaughn, James D. Lewis
Diabetes Care Jul 2014, 37 (7) 1910-1917; DOI: 10.2337/dc13-1489

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Incidence of Bladder Cancer in Patients With Type 2 Diabetes Treated With Metformin or Sulfonylureas
Ronac Mamtani, Nick Pfanzelter, Kevin Haynes, Brian S. Finkelman, Xingmei Wang, Stephen M. Keefe, Naomi B. Haas, David J. Vaughn, James D. Lewis
Diabetes Care Jul 2014, 37 (7) 1910-1917; DOI: 10.2337/dc13-1489
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