title: Treatment with insulin secretagogues and cancer-related mortality in type 2 diabetic patients a retrospective cohort study.
abstract: BACKGROUND
  Recent evidence suggests that some hypoglycemic treatments could affect the incidence of malignancies. This study was aimed at the assessment of cancer-related mortality in type 2 diabetic patients treated with different hypoglycemic drugs.
  
  
  METHODS
  A retrospective observational cohort study was performed on a consecutive series of 3002 type 2 diabetic outpatients. Cancer-related death was identified through the City Registry Office. For patients visited for the first time after January 1 (st), 2000, information on incidence of cancer was also available.
  
  
  RESULTS
  During a mean follow-up of 4.3+/-2.5 years, 87 cases of cancer-related death were recorded, with a yearly incidence rate of 0.70%. Patients receiving secretagogues showed a significantly higher mortality than the rest of the sample (unadjusted OR [95%CI] 1.76 [1.15-2.69], p=0.009), which was maintained after adjustment for confounders (HR 2.29 [1.21-4.02], p=0.003). Conversely, no significant association of cancer-related mortality was observed with insulin sensitizers or exogenous insulin. In comparison with patients receiving no hypoglycemic treatment, those on secretagogue or insulin monotherapy showed a higher cancer-related mortality (HR 2.25 [1.10-4.78], p=0.034 and HR 2.11 [1.01-4.50], p=0.048, respectively). The effect of treatments on incidence of malignancies was similar to that observed on cancer-related death.
  
  
  CONCLUSIONS
  Insulin secretagogues and, to a lesser extent, exogenous insulin, appear to be associated with increased mortality for cancer, even after adjustment for multiple confounders. This issue deserves further investigation through epidemiological studies on larger samples of patients.
authors.affiliation: Department of Critical Care Medicine and Surgery, Unit of Geriatrics, University of Florence, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Monami
authors.forename: C
authors.initials: C
authors.lastname: Lamanna
authors.forename: L
authors.initials: L
authors.lastname: Pala
authors.forename: G
authors.initials: G
authors.lastname: Bardini
authors.forename: B
authors.initials: B
authors.lastname: Cresci
authors.forename: P
authors.initials: P
authors.lastname: Francesconi
authors.forename: D
authors.initials: D
authors.lastname: Balzi
authors.forename: N
authors.initials: N
authors.lastname: Marchionni
authors.forename: C M
authors.initials: CM
authors.lastname: Rotella
authors.forename: E
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin