Risk of cancer in patients using glucose-lowering agents: a nationwide cohort study of 3.6 million people.
OBJECTIVE
To study the association between exposures to glucose-lowering therapy and risk of cancer using the nationwide administrative registers in Denmark.


METHODS
Nationwide cohort study.


METHODS
All hospitals in Denmark.


METHODS
All individuals aged ≥35 years in 1998-2009 who were naive to glucose-lowering treatment and had no history of cancer. Primary measures outcomes: first cancer diagnosis between 1998 and 2009. The RR of cancer as dependent on exposure to individual glucose-lowering agents was assessed by multivariable Poisson regression models.


RESULTS
Of 159 894 patients that initiated treatment with glucose-lowering agents, 12 789 developed cancer, incidence rate 17.4/1000 person-years. Of the remaining 3 447 904 individuals not using glucose-lowering agents, 293 878 developed cancer, incidence rate 7.9/1000 person-years. Use of different types of glucose-lowering agents including human insulin, insulin analogues, as well as sulfonylureas were associated with a quantitatively similar and significantly increased RR of cancer of 1.2-1.3 compared with unexposed individuals after multivariable adjustment. For the majority of agents, the authors identified the highest RR of cancer during the first 30 treatment days with a subsequent decline of risk approaching the cancer risk of the background population only 6-12 months after initiation of treatments.


CONCLUSIONS
Use of most glucose-lowering agents including sulfonylureas was associated with a comparable increased risk of cancer shortly after initiation of treatment and subsequently a decline to the risk of the background population. This suggests that the relation is not causal.
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Charlotte
C
Andersson
Allan
A
Vaag
Christian
C
Selmer
Michelle
M
Schmiegelow
Rikke
R
Sørensen
Jesper
J
Lindhardsen
Gunnar H
GH
Gislason
Lars
L
Køber
Christian
C
Torp-Pedersen