title: A population-based cohort study in Taiwan--use of insulin sensitizers can decrease cancer risk in diabetic patients?
abstract: BACKGROUND
  The purpose of the study was to explore the possible association between the use of insulin sensitizers (thiazolidinediones, TZDs) and the risk of cancer in Taiwanese diabetic patients.
  
  
  METHODS
  From the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22 910 diabetic patients newly diagnosed from 2001 to 2009 and 91 636 non-diabetic comparisons frequency matched with age, sex, and calendar year, excluding those with cancer at the baseline. Among the diabetics, 4159 patients were treated with TZDs and the rest of 18 752 patients were on other anti-diabetic medications (non-TZDs).
  
  
  RESULTS
  In comparison to the non-diabetes group, the non-TZDs group had an increased risk of developing cancer [the adjusted hazard ratio (HR): 1.20 and 95% confidence interval (CI) = 1.11-1.30]. The TZDs group had a HR of 1.18 (95% CI = 0.98-1.42). Analysis of site-specific cancer risks showed that both TZDs and non-TZDs groups with elevated risks of colorectal and pancreatic cancer. However, the non-TZDs group had an increased risk of liver cancer when comparing with TZD and non-diabetes groups.
  
  
  CONCLUSIONS
  This study suggests that patients with diabetes are at an elevated risk of cancer (especially in colorectal and pancreatic cancers), and the use of TZDs might decrease the liver cancer risk in diabetic patients. Further investigation using large samples and rigorous methodology is warranted.
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung. Electronic address: d10040@mail.cmuh.org.tw.
authors.forename: C-H
authors.initials: CH
authors.lastname: Kao
authors.affiliation: Department of Radiation Oncology, Zuoying Armed Forces General Hospital, Kaohsiung.
authors.forename: L-M
authors.initials: LM
authors.lastname: Sun
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipe.
authors.forename: P-C
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Nuclear Medicine, E-DA Hospital, Kaohsiung.
authors.forename: M-C
authors.initials: MC
authors.lastname: Lin
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine; Department of Radiation Oncology.
authors.forename: J-A
authors.initials: JA
authors.lastname: Liang
authors.affiliation: Management Office for Health Data; Department of Public Health, College of Public Health.
authors.forename: C-H
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Department of Public Health, College of Public Health; The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University, Taichung; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
authors.forename: S-N
authors.initials: SN
authors.lastname: Chang
authors.affiliation: Department of Public Health, College of Public Health.
authors.forename: F-C
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D013624:Taiwan; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones