title: Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai.
abstract: OBJECTIVE
  The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Yunjuan
authors: Y
authors: Gu
authors: Chunfang
authors: C
authors: Wang
authors: Ying
authors: Y
authors: Zheng
authors: Xuhong
authors: X
authors: Hou
authors: Yifei
authors: Y
authors: Mo
authors: Weihui
authors: W
authors: Yu
authors: Lei
authors: L
authors: Zhang
authors: Cheng
authors: C
authors: Hu
authors: Hairong
authors: H
authors: Nan
authors: Lei
authors: L
authors: Chen
authors: Jie
authors: J
authors: Li
authors: Yuxiang
authors: Y
authors: Liu
authors: Zhezhou
authors: Z
authors: Huang
authors: Ming
authors: M
authors: Han
authors: Yuqian
authors: Y
authors: Bao
authors: Weijian
authors: W
authors: Zhong
authors: Weiping
authors: W
authors: Jia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012042:Registries; D012306:Risk
chemical_list: D007328:Insulin; D011994:Recombinant Proteins