title: Pharmacologic Therapy of Diabetes and Overall Cancer Risk and Mortality: A Meta-Analysis of 265 Studies.
abstract: Different anti-diabetic medications (ADMs) may modify cancer risk and mortality in patients with diabetes. We conducted a systematic review and meta-analysis to estimate the magnitude of association and quality of supporting evidence for each ADM. A total of 265 studies (44 cohort studies, 39 case-control studies, and 182 randomized controlled trials (RCT)) were identified, involving approximately 7.6 million and 137,540 patients with diabetes for observational studies and RCTs, respectively. The risk of bias overall was moderate. Meta-analysis demonstrated that the use of metformin or thiazolidinediones was associated with a lower risk of cancer incidence (RR = 0.86, 95% CI 0.83-0.90, I(2) = 88.61%; RR = 0.93, 95% CI 0.91-0.96, I(2) = 0.00% respectively). On the other hand, insulin, sulfonylureas and alpha glucosidase inhibitor use was associated with an increased risk of cancer incidence (RR = 1.21, 95% CI 1.08-1.36, I(2) = 96.31%; RR = 1.20, 95% CI 1.13-1.27, I(2) = 95.02%; RR = 1.10, 95% CI 1.05-1.15, I(2) = 0.00% respectively). Use of other types of ADMs was not significantly associated with cancer risk. This study indicates that some ADMs may modify the risk of cancer in individuals with diabetes. Knowledge of this risk may affect the choice of ADM in individuals concerned about cancer or at increased risk for cancer.
authors.affiliation: Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lang
authors.initials: L
authors.lastname: Wu
authors.affiliation: Program of Quantitative Methods in Education, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: 1] Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota [2] Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D065089:Glycoside Hydrolase Inhibitors / Q000009:adverse effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D008687:Metformin / Q000627:therapeutic use; D009369:Neoplasms / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013453:Sulfonylurea Compounds / Q000009:adverse effects*; D045162:Thiazolidinediones / Q000627:therapeutic use
chemical_list: D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin