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Insulin glargine and cancer risk in patients with diabetes: a meta-analysis.

Tang X, Yang L, He Z, Liu J - PLoS ONE (2012)

Bottom Line: Insulin glargine use was associated with a lower odds of cancer compared with non-glargine insulin use (OR 0.81, 95% CI 0.68 to 0.98, P = 0.03; very low-quality evidence).Glargine did not increase the odds of breast cancer (OR 0.99, 95% CI 0.68 to 1.46, P = 0.966; very low-quality evidence).Compared with non-glargine insulin, no significant association was found between insulin glargine and prostate cancer, pancreatic cancer and respiratory tract cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China. xulei_tang@126.com

ABSTRACT

Aim: The role of insulin glargine as a risk factor for cancer is controversial in human studies. The aim of this meta-analysis was to evaluate the relationship between insulin glargine and cancer incidence.

Methods: All observational studies and randomized controlled trials evaluating the relationship of insulin glargine and cancer risk were identified in PubMed, Embase, Web of Science, Cochrane Library and the Chinese Biomedical Medical Literature Database, through March 2012. Odds ratios (ORs) with corresponding 95% confidence interval (CI) were calculated with a random-effects model. Confidence in the estimates of the obtained effects (quality of evidence) was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: A total of 11 studies including 448,928 study subjects and 19,128 cancer patients were finally identified for the meta-analysis. Insulin glargine use was associated with a lower odds of cancer compared with non-glargine insulin use (OR 0.81, 95% CI 0.68 to 0.98, P = 0.03; very low-quality evidence). Glargine did not increase the odds of breast cancer (OR 0.99, 95% CI 0.68 to 1.46, P = 0.966; very low-quality evidence). Compared with non-glargine insulin, no significant association was found between insulin glargine and prostate cancer, pancreatic cancer and respiratory tract cancer. Insulin glargine use was associated with lower odds of other site-specific cancer.

Conclusions: Results from the meta-analysis don't support the link between insulin glargine and an increased risk of cancer and the confidence in the estimates of the effects is very low. Further studies are needed to examine the relation between insulin glargine and cancer risk, especially breast cancer.

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Related in: MedlinePlus

Flow diagram of study selection process.CBM, the Chinese Biomedical Medical Literature Database.
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pone-0051814-g001: Flow diagram of study selection process.CBM, the Chinese Biomedical Medical Literature Database.

Mentions: A detailed flow diagram of the study selection for the meta-analysis is presented in Figure 1. A total of 608 potentially related studies were identified via the search strategy listed in previous section. After finding duplicates and reviewing the titles, abstracts and full texts, 11 studies including 448, 928 study subjects and 19, 128 cancer patients were finally identified for the meta-analysis [7], [8], [23]–[31]. The study design consisted of 1 RCT [31] and 10 observational studies (1 case-control study [30] and 9 cohort studies [7], [8], [23]–[29]). The data were obtained from ten countries: Netherland, France, UK, USA, Sweden, China, Italy, Canada, Germany and Scotland. The study by Mannucci et al [30] used self-reported and prescription record data on insulin glargine therapy use, others used prescription record data [7], [8], [23]–[29], [31]. Only 8 studies [7], [8], [23], [24], [26]–[29] adjusted for confounders, such as age, sex, type of diabetes, comorbidities and concomitant drug (Table 1). A study [26] that excluded patients with a history of breast cancer only reported the association between insulin glargine and the risk of breast cancer, but not report relative risk of insulin glargine and overall cancer. Two studies [7], [27] included some patients with a history of cancer before cohort entry. The main baseline characteristics of the included studies are reported in Table 1. Table 2 summarizes the findings and the quality of the evidence for insulin glargine compared with non-glargine insulin therapy.


Insulin glargine and cancer risk in patients with diabetes: a meta-analysis.

Tang X, Yang L, He Z, Liu J - PLoS ONE (2012)

Flow diagram of study selection process.CBM, the Chinese Biomedical Medical Literature Database.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3526637&req=5

pone-0051814-g001: Flow diagram of study selection process.CBM, the Chinese Biomedical Medical Literature Database.
Mentions: A detailed flow diagram of the study selection for the meta-analysis is presented in Figure 1. A total of 608 potentially related studies were identified via the search strategy listed in previous section. After finding duplicates and reviewing the titles, abstracts and full texts, 11 studies including 448, 928 study subjects and 19, 128 cancer patients were finally identified for the meta-analysis [7], [8], [23]–[31]. The study design consisted of 1 RCT [31] and 10 observational studies (1 case-control study [30] and 9 cohort studies [7], [8], [23]–[29]). The data were obtained from ten countries: Netherland, France, UK, USA, Sweden, China, Italy, Canada, Germany and Scotland. The study by Mannucci et al [30] used self-reported and prescription record data on insulin glargine therapy use, others used prescription record data [7], [8], [23]–[29], [31]. Only 8 studies [7], [8], [23], [24], [26]–[29] adjusted for confounders, such as age, sex, type of diabetes, comorbidities and concomitant drug (Table 1). A study [26] that excluded patients with a history of breast cancer only reported the association between insulin glargine and the risk of breast cancer, but not report relative risk of insulin glargine and overall cancer. Two studies [7], [27] included some patients with a history of cancer before cohort entry. The main baseline characteristics of the included studies are reported in Table 1. Table 2 summarizes the findings and the quality of the evidence for insulin glargine compared with non-glargine insulin therapy.

Bottom Line: Insulin glargine use was associated with a lower odds of cancer compared with non-glargine insulin use (OR 0.81, 95% CI 0.68 to 0.98, P = 0.03; very low-quality evidence).Glargine did not increase the odds of breast cancer (OR 0.99, 95% CI 0.68 to 1.46, P = 0.966; very low-quality evidence).Compared with non-glargine insulin, no significant association was found between insulin glargine and prostate cancer, pancreatic cancer and respiratory tract cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China. xulei_tang@126.com

ABSTRACT

Aim: The role of insulin glargine as a risk factor for cancer is controversial in human studies. The aim of this meta-analysis was to evaluate the relationship between insulin glargine and cancer incidence.

Methods: All observational studies and randomized controlled trials evaluating the relationship of insulin glargine and cancer risk were identified in PubMed, Embase, Web of Science, Cochrane Library and the Chinese Biomedical Medical Literature Database, through March 2012. Odds ratios (ORs) with corresponding 95% confidence interval (CI) were calculated with a random-effects model. Confidence in the estimates of the obtained effects (quality of evidence) was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: A total of 11 studies including 448,928 study subjects and 19,128 cancer patients were finally identified for the meta-analysis. Insulin glargine use was associated with a lower odds of cancer compared with non-glargine insulin use (OR 0.81, 95% CI 0.68 to 0.98, P = 0.03; very low-quality evidence). Glargine did not increase the odds of breast cancer (OR 0.99, 95% CI 0.68 to 1.46, P = 0.966; very low-quality evidence). Compared with non-glargine insulin, no significant association was found between insulin glargine and prostate cancer, pancreatic cancer and respiratory tract cancer. Insulin glargine use was associated with lower odds of other site-specific cancer.

Conclusions: Results from the meta-analysis don't support the link between insulin glargine and an increased risk of cancer and the confidence in the estimates of the effects is very low. Further studies are needed to examine the relation between insulin glargine and cancer risk, especially breast cancer.

Show MeSH
Related in: MedlinePlus