title: Anti-diabetic medications and risk of primary liver cancer in persons with type II diabetes.
abstract: BACKGROUND
  Type II diabetes increases liver cancer risk but the risk may be mitigated by anti-diabetic medications. However, choice of medications is correlated with diabetes duration and severity, leading to confounding by indication.
  
  
  METHODS
  To address this association, we conducted a nested case-control study among persons with type II diabetes in the Clinical Practice Research Datalink. Cases had primary liver cancer and controls were matched on age, sex, practice, calendar time, and number of years in the database. Exposure was classified by type and combination of anti-diabetic prescribed and compared to non-use. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated using conditional logistic regression.
  
  
  RESULTS
  In 305 cases of liver cancer and 1151 controls, there was no association between liver cancer and anti-diabetic medication use compared to non-use (OR=0.74 (95% CI=0.45-1.20) for metformin-only, 1.10 (95% CI=0.66-1.84) for other oral hypoglycaemic (OH)-only, 0.89 (95% CI=0.58-1.37) for metformin+other OH, 1.11 (95% CI=0.60-2.05) for metformin+insulin, 0.81 (95% CI=0.23-2.85) for other OH+insulin, and 0.72 (95% CI=0.18-2.84) for insulin-only). Stratification by duration of diabetes did not alter the results.
  
  
  CONCLUSIONS
  Use of any anti-diabetic medications in patients with type II diabetes was not associated with liver cancer, though there was a suggestion of a small protective effect for metformin.
authors.affiliation: Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, 11 Muzzey Street, Lexington, MA 02421, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Hagberg
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: McGlynn
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
authors.forename: V V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.affiliation: Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, 11 Muzzey Street, Lexington, MA 02421, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
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