title: Cancer risk associated with insulin glargine among adult type 2 diabetes patients--a nationwide cohort study.
abstract: BACKGROUND
  Preclinical and observational studies raise the concern about the safety of insulin glargine in terms of cancer initiation and promotion. This study is designed to examine cancer incidence associated with use of insulin glargine vs. intermediate/long-acting human insulin (HI).
  
  
  METHODS
  A retrospective cohort study using the Taiwan National Health Insurance claims database was conducted to identify adult patients with type 2 diabetes mellitus and without a history of cancer who initiated insulin glargine (n = 10,190) or intermediate/long-acting HI (n = 49,253) during 2004-2007. Exclusive users were followed from the date of insulin initiation to the earliest of cancer diagnosis, death, disenrollment, or December 31 2007. We estimated adjusted hazard ratios and 95% confidence intervals (CIs) with Cox proportional hazards models adjusting for baseline propensity score.
  
  
  RESULTS
  The incidence rate of all cancer per 1,000 person-years was 13.8 for insulin glargine initiators (179 cases) and 16.0 for intermediate/long-acting HI initiators (1,445 cases) during an average follow-up of 2 years. No significant difference in overall cancer risk between insulin glargine initiators and HI initiators was found. For men, however, the adjusted hazard ratio of insulin glargine use as compared with intermediate/long-acting HI was 2.15 (95% CI 1.01-4.59) for pancreatic cancer, and 2.42 (95% CI 1.50-8.40) for prostate cancer. The increased risk was not observed among women.
  
  
  CONCLUSIONS
  Insulin glargine use did not increase the risk of overall cancer incidence as compared with HI. The positive associations with pancreatic and prostate cancer need further evaluation and validation.
authors: Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Chia-Hsuin
authors: CH
authors: Chang
authors: Sengwee
authors: S
authors: Toh
authors: Jou-Wei
authors: JW
authors: Lin
authors: Shu-Ting
authors: ST
authors: Chen
authors: Chuei-Wen
authors: CW
authors: Kuo
authors: Lee-Ming
authors: LM
authors: Chuang
authors: Mei-Shu
authors: MS
authors: Lai
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000209:etiology; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D049528:Insulin, Long-Acting; D000069036:Insulin Glargine