Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai
The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes. We 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...
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| Veröffentlicht in: | PloS one 2013-01, Vol.8 (1), p.e53411-e53411 |
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| creator | Gu, Yunjuan Wang, Chunfang Zheng, Ying Hou, Xuhong Mo, Yifei Yu, Weihui Zhang, Lei Hu, Cheng Nan, Hairong Chen, Lei Li, Jie Liu, Yuxiang Huang, Zhezhou Han, Ming Bao, Yuqian Zhong, Weijian Jia, Weiping |
| description | The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.
We 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.
We 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 |
| doi_str_mv | 10.1371/journal.pone.0053411 |
| format | Article |
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We 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.
We 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.
There 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0053411</identifier><identifier>PMID: 23308218</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analysis ; Cancer ; Cancer patients ; China ; Cohort analysis ; Cohort Studies ; Colorectal cancer ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - mortality ; Diabetics ; Disease control ; Disease prevention ; Disease-Free Survival ; Endocrinology ; Female ; Hazards ; Health risk assessment ; Health risks ; Humans ; Incidence ; Insulin ; Insulin - pharmacology ; Insulin - therapeutic use ; Laboratories ; Liver ; Liver cancer ; Liver Neoplasms - complications ; Liver Neoplasms - drug therapy ; Liver Neoplasms - mortality ; Male ; Medical diagnosis ; Medical research ; Medicine ; Metabolism ; Middle Aged ; Mortality ; Neoplasms - complications ; Neoplasms - drug therapy ; Neoplasms - mortality ; Patient outcomes ; Patients ; Population ; Proportional Hazards Models ; Recombinant Proteins - pharmacology ; Recombinant Proteins - therapeutic use ; Registries ; Risk ; Risk factors ; Statistical models ; Studies ; Type 2 diabetes ; Vital statistics</subject><ispartof>PloS one, 2013-01, Vol.8 (1), p.e53411-e53411</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Gu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Gu et al 2013 Gu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-2e71f8e9a10379b948e0981d58ed7065fe511a76fa0f607d3ea1c72ae4076e673</citedby><cites>FETCH-LOGICAL-c692t-2e71f8e9a10379b948e0981d58ed7065fe511a76fa0f607d3ea1c72ae4076e673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538755/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538755/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23308218$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gu, Yunjuan</creatorcontrib><creatorcontrib>Wang, Chunfang</creatorcontrib><creatorcontrib>Zheng, Ying</creatorcontrib><creatorcontrib>Hou, Xuhong</creatorcontrib><creatorcontrib>Mo, Yifei</creatorcontrib><creatorcontrib>Yu, Weihui</creatorcontrib><creatorcontrib>Zhang, Lei</creatorcontrib><creatorcontrib>Hu, Cheng</creatorcontrib><creatorcontrib>Nan, Hairong</creatorcontrib><creatorcontrib>Chen, Lei</creatorcontrib><creatorcontrib>Li, Jie</creatorcontrib><creatorcontrib>Liu, Yuxiang</creatorcontrib><creatorcontrib>Huang, Zhezhou</creatorcontrib><creatorcontrib>Han, Ming</creatorcontrib><creatorcontrib>Bao, Yuqian</creatorcontrib><creatorcontrib>Zhong, Weijian</creatorcontrib><creatorcontrib>Jia, Weiping</creatorcontrib><title>Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.
We 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.
We 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.
There 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Cancer</subject><subject>Cancer patients</subject><subject>China</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colorectal cancer</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - mortality</subject><subject>Diabetics</subject><subject>Disease control</subject><subject>Disease prevention</subject><subject>Disease-Free Survival</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Hazards</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Humans</subject><subject>Incidence</subject><subject>Insulin</subject><subject>Insulin - pharmacology</subject><subject>Insulin - therapeutic use</subject><subject>Laboratories</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver Neoplasms - complications</subject><subject>Liver Neoplasms - drug therapy</subject><subject>Liver Neoplasms - mortality</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - drug therapy</subject><subject>Neoplasms - mortality</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Population</subject><subject>Proportional Hazards Models</subject><subject>Recombinant Proteins - pharmacology</subject><subject>Recombinant Proteins - therapeutic use</subject><subject>Registries</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Statistical models</subject><subject>Studies</subject><subject>Type 2 diabetes</subject><subject>Vital statistics</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11v0zAUhiMEYmPwDxBEQkJw0eKPxE64QJoqPipNmsSAW-skOWk8pXZnO4P-e9w2mxq0C5QLW8fP-9p-nZMkLymZUy7ph2s7OAP9fGMNzgnJeUbpo-SUlpzNBCP88dH8JHnm_fUOKoR4mpwwzknBaHGa3C7A1OhSbWrdYJymYJp0bV2AXodtrKcbCBpN8OlvHbo0bDeYsrTRUGFAnwaHELA5LHbDGkzU-KHX5mMKaW27aJX6MDR7r6sOzKoD_Tx50kLv8cU4niU_v3z-sfg2u7j8ulycX8xqUbIwYyhpW2AJlHBZVmVWICkL2uQFNpKIvMWcUpCiBdIKIhuOQGvJADMiBQrJz5LXB99Nb70aI_OKsqIkIsZRRmJ5IBoL12rj9BrcVlnQal-wbqXABV33qEqaVxXjFCgtM-S8iAcSecWQNAhQi-j1adxtqNbY1DE1B_3EdLpidKdW9lbx-DAyz6PBu9HA2ZsBfVBr7WvsezBoh925Jc94nrEiom_-QR--3UitIF5Am9bGfeudqTrPZJERSvcpzR-g4tfgWtfx_2p1rE8E7yeCyAT8E1YweK-WV9__n738NWXfHrEdQh86b_shaGv8FMwOYO2s9w7b-5ApUbv2uEtD7dpDje0RZa-OH-hedNcP_C_hJwo3</recordid><startdate>20130107</startdate><enddate>20130107</enddate><creator>Gu, 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Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gu, Yunjuan</au><au>Wang, Chunfang</au><au>Zheng, Ying</au><au>Hou, Xuhong</au><au>Mo, Yifei</au><au>Yu, Weihui</au><au>Zhang, Lei</au><au>Hu, Cheng</au><au>Nan, Hairong</au><au>Chen, Lei</au><au>Li, Jie</au><au>Liu, Yuxiang</au><au>Huang, Zhezhou</au><au>Han, Ming</au><au>Bao, Yuqian</au><au>Zhong, Weijian</au><au>Jia, Weiping</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-01-07</date><risdate>2013</risdate><volume>8</volume><issue>1</issue><spage>e53411</spage><epage>e53411</epage><pages>e53411-e53411</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.
We 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.
We 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.
There 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23308218</pmid><doi>10.1371/journal.pone.0053411</doi><tpages>e53411</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2013-01, Vol.8 (1), p.e53411-e53411 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1289060539 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adult Aged Aged, 80 and over Analysis Cancer Cancer patients China Cohort analysis Cohort Studies Colorectal cancer Diabetes Diabetes mellitus Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - mortality Diabetics Disease control Disease prevention Disease-Free Survival Endocrinology Female Hazards Health risk assessment Health risks Humans Incidence Insulin Insulin - pharmacology Insulin - therapeutic use Laboratories Liver Liver cancer Liver Neoplasms - complications Liver Neoplasms - drug therapy Liver Neoplasms - mortality Male Medical diagnosis Medical research Medicine Metabolism Middle Aged Mortality Neoplasms - complications Neoplasms - drug therapy Neoplasms - mortality Patient outcomes Patients Population Proportional Hazards Models Recombinant Proteins - pharmacology Recombinant Proteins - therapeutic use Registries Risk Risk factors Statistical models Studies Type 2 diabetes Vital statistics |
| title | Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai |
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