title: Electronic medical record cancer incidence over six years comparing new users of glargine with new users of NPH insulin.
abstract: BACKGROUND
  Recent studies suggested that insulin glargine use could be associated with increased risk of cancer. We compared the incidence of cancer in new users of glargine versus new users of NPH in a longitudinal clinical cohort with diabetes for up to 6 years.
  
  
  RESULTS
  From all patients who had been regularly followed at Massachusetts General Hospital from 1/01/2005 to 12/31/2010, 3,680 patients who had a medication record for glargine or NPH usage were obtained from the electronic medical record (EMR). From those we selected 539 new glargine users (age: 60.1±13.6 years, BMI: 32.7±7.5 kg/m2) and 343 new NPH users (61.5±14.1 years, 32.7±8.3 kg/m2) who had no prevalent cancer during 19 months prior to glargine or NPH initiation. All incident cancer cases were ascertained from the EMR requiring at least 2 ICD-9 codes within a 2 month period. Insulin exposure time and cumulative dose were validated. The statistical analysis compared the rates of cancer in new glargine vs. new NPH users while on treatment, adjusted for the propensity to receive one or the other insulin. There were 26 and 28 new cancer cases in new glargine and new NPH users for 1559 and 1126 person-years follow-up, respectively. There were no differences in the propensity-adjusted clinical characteristics between groups. The adjusted hazard ratio for the cancer incidence comparing glargine vs. NPH use was 0.65 (95% CI: 0.36-1.19).
  
  
  CONCLUSIONS
  Insulin glargine is not associated with development of cancers when compared with NPH in this longitudinal and carefully retrieved EMR data.
authors.affiliation: General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America; Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Soo
authors.initials: S
authors.lastname: Lim
authors.affiliation: General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America; Center for Human Genetic Research, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Katherine G
authors.initials: KG
authors.lastname: Stember
authors.affiliation: General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.affiliation: General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Porneala C
authors.initials: PC
authors.lastname: Bianca
authors.affiliation: General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Carine
authors.initials: C
authors.lastname: Yelibi
authors.affiliation: Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Alison
authors.initials: A
authors.lastname: Marquis
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: Til
authors.initials: T
authors.lastname: Stürmer
authors.affiliation: Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: John B
authors.initials: JB
authors.lastname: Buse
authors.affiliation: General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
mesh_terms: D003920:Diabetes Mellitus / Q000188:drug therapy; D018572:Disease-Free Survival; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D015994:Incidence; D000069036:Insulin Glargine; D007336:Insulin, Isophane / Q000009:adverse effects* / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced*; D013997:Time Factors
chemical_list: D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D007336:Insulin, Isophane