title: Cancer incidence among those initiating insulin therapy with glargine versus human NPH insulin.
abstract: OBJECTIVE
  To add to the evidence on comparative long-term effects of insulin analog glargine versus human NPH insulin on the risk for cancer.
  
  
  METHODS
  We identified cohorts of initiators of glargine and human NPH without an insulin prescription during the prior 19 months among patients covered by the Inovalon Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry) between January 2003 and December 2010. Patients were required to have a second prescription of the same insulin within 180 days and to be free of cancer. We balanced cohorts on risk factors for cancer outcomes based on comorbidities, comedication, and health care use during the prior 12 months using inverse probability of treatment weighting. Incident cancer was defined as having two claims for cancer (any cancer) or the same cancer (breast, prostate, colon) within 2 months. We estimated adjusted hazard ratios (HRs) and their 95% CI using weighted Cox models censoring for stopping, switching, or augmenting insulin treatment, end of enrollment, and mortality.
  
  
  RESULTS
  More patients initiated glargine (43,306) than NPH (9,147). Initiators of glargine (NPH) were followed for 1.2 (1.1) years and 50,548 (10,011) person-years; 993 (178) developed cancer. The overall HR was 1.12 (95% CI 0.95-1.32). Results were consistent for breast cancer, prostate cancer, and colon cancer; various durations of treatment; and sensitivity analyses.
  
  
  CONCLUSIONS
  Patients initiating insulin glargine rather than NPH do not seem to be at an increased risk for cancer. While our study contributes significantly to our evidence base for long-term effects, this evidence is very limited mainly based on actual dynamics in insulin prescribing.
authors.affiliation: Corresponding author: John B. Buse, jbuse@med.unc.edu.
authors.forename: Til
authors.initials: T
authors.lastname: Stürmer
authors.forename: M Alison
authors.initials: MA
authors.lastname: Marquis
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhou
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
authors.forename: Soo
authors.initials: S
authors.lastname: Lim
authors.forename: Lawrence
authors.initials: L
authors.lastname: Blonde
authors.forename: Eileen
authors.initials: E
authors.lastname: Macdonald
authors.forename: Ray
authors.initials: R
authors.lastname: Wang
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lavange
authors.forename: Virginia
authors.initials: V
authors.lastname: Pate
authors.forename: John B
authors.initials: JB
authors.lastname: Buse
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D000069036:Insulin Glargine; D007336:Insulin, Isophane / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D061386:Insulin, Regular, Human / Q000627:therapeutic use*; D000068880:Isophane Insulin, Human; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D011336:Probability; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D061386:Insulin, Regular, Human; D000068880:Isophane Insulin, Human; D000069036:Insulin Glargine; D007336:Insulin, Isophane