File Download
Links for fulltext
(May Require Subscription)
- Publisher Website: 10.1136/bmjdrc-2020-001346
- Scopus: eid_2-s2.0-85086605388
- PMID: 32532851
- WOS: WOS:000573913300008
- Find via
Supplementary
- Citations:
- Appears in Collections:
Article: DPP4i, thiazolidinediones, or insulin and risks of cancer in patients with type 2 diabetes mellitus on metformin–sulfonylurea dual therapy with inadequate control
Title | DPP4i, thiazolidinediones, or insulin and risks of cancer in patients with type 2 diabetes mellitus on metformin–sulfonylurea dual therapy with inadequate control |
---|---|
Authors | |
Keywords | cancer insulin thiazolidinediones type 2 diabetes |
Issue Date | 2020 |
Publisher | BMJ Publishing Group: Open Access. The Journal's web site is located at http://drc.bmj.com/ |
Citation | BMJ Open Diabetes Research & Care, 2020, v. 8 n. 1, p. article no. e001346 How to Cite? |
Abstract | Introduction This study aims to compare the risks of cancer among patients with type 2 diabetes mellitus (T2DM) on metformin–sulfonylurea dual therapy intensified with dipeptidyl peptidase 4 inhibitors (DPP4i), thiazolidinediones, or insulin. Research design and methods We assembled a retrospective cohort data of 20 577 patients who were free of cancer and on metformin–sulfonylurea dual therapy, and whose drug treatments were intensified with DPP4i (n=9957), insulin (n=7760), or thiazolidinediones (n=2860) from January 2006 to December 2017. Propensity-score weighting was used to balance out baseline covariates across the three groups. HRs for any types of cancer, cancer mortality, and all-cause mortality were assessed using Cox proportional-hazards models. Results Over a mean follow-up period of 34 months with 58 539 person-years, cumulative incidences of cancer, cancer mortality, and all-cause mortality were 0.028, 0.009, and 0.072, respectively. Patients intensified with insulin had the highest incidence of all-cause mortality (incidence rate=3.22/100 person-years) and the insulin itself posed the greatest risk (HR 2.46, 95% CI 2.25 to 2.70, p<0.001; 2.44, 95% CI 2.23 to 2.67) compared with thiazolidinediones and DPP4i, respectively. Comparing between thiazolidinediones and DPP4i, thiazolidinediones was associated with higher risk of cancer (HR 1.43, 95% CI 1.25 to 1.63) but not cancer mortality (HR 1.21, 95% CI 0.92 to 1.58) and all-cause mortality (HR 0.99, 95% CI 0.88 to 1.11). Insulin was associated with the greatest risk of cancer mortality (HR 1.36, 95% CI 1.09 to 1.71; 1.65, 95% CI 1.31 to 2.07) compared with thiazolidinediones and DPP4i, respectively. Conclusions For patients with T2DM on metformin–sulfonylurea dual therapy, the addition of DPP4i was the third-line medication least likely to be associated with cancer mortality and cancer effect among three options, and posed no increased risk for all-cause mortality when compared with thiazolidinediones. |
Persistent Identifier | http://hdl.handle.net/10722/283254 |
ISSN | 2023 Impact Factor: 3.7 2023 SCImago Journal Rankings: 1.479 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
---|---|---|
dc.contributor.author | Wong, CKH | - |
dc.contributor.author | Man, KCK | - |
dc.contributor.author | Chan, EWY | - |
dc.contributor.author | WU, T | - |
dc.contributor.author | Tse, ETY | - |
dc.contributor.author | Wong, ICK | - |
dc.contributor.author | Lam, CLK | - |
dc.date.accessioned | 2020-06-22T02:54:11Z | - |
dc.date.available | 2020-06-22T02:54:11Z | - |
dc.date.issued | 2020 | - |
dc.identifier.citation | BMJ Open Diabetes Research & Care, 2020, v. 8 n. 1, p. article no. e001346 | - |
dc.identifier.issn | 2052-4897 | - |
dc.identifier.uri | http://hdl.handle.net/10722/283254 | - |
dc.description.abstract | Introduction This study aims to compare the risks of cancer among patients with type 2 diabetes mellitus (T2DM) on metformin–sulfonylurea dual therapy intensified with dipeptidyl peptidase 4 inhibitors (DPP4i), thiazolidinediones, or insulin. Research design and methods We assembled a retrospective cohort data of 20 577 patients who were free of cancer and on metformin–sulfonylurea dual therapy, and whose drug treatments were intensified with DPP4i (n=9957), insulin (n=7760), or thiazolidinediones (n=2860) from January 2006 to December 2017. Propensity-score weighting was used to balance out baseline covariates across the three groups. HRs for any types of cancer, cancer mortality, and all-cause mortality were assessed using Cox proportional-hazards models. Results Over a mean follow-up period of 34 months with 58 539 person-years, cumulative incidences of cancer, cancer mortality, and all-cause mortality were 0.028, 0.009, and 0.072, respectively. Patients intensified with insulin had the highest incidence of all-cause mortality (incidence rate=3.22/100 person-years) and the insulin itself posed the greatest risk (HR 2.46, 95% CI 2.25 to 2.70, p<0.001; 2.44, 95% CI 2.23 to 2.67) compared with thiazolidinediones and DPP4i, respectively. Comparing between thiazolidinediones and DPP4i, thiazolidinediones was associated with higher risk of cancer (HR 1.43, 95% CI 1.25 to 1.63) but not cancer mortality (HR 1.21, 95% CI 0.92 to 1.58) and all-cause mortality (HR 0.99, 95% CI 0.88 to 1.11). Insulin was associated with the greatest risk of cancer mortality (HR 1.36, 95% CI 1.09 to 1.71; 1.65, 95% CI 1.31 to 2.07) compared with thiazolidinediones and DPP4i, respectively. Conclusions For patients with T2DM on metformin–sulfonylurea dual therapy, the addition of DPP4i was the third-line medication least likely to be associated with cancer mortality and cancer effect among three options, and posed no increased risk for all-cause mortality when compared with thiazolidinediones. | - |
dc.language | eng | - |
dc.publisher | BMJ Publishing Group: Open Access. The Journal's web site is located at http://drc.bmj.com/ | - |
dc.relation.ispartof | BMJ Open Diabetes Research & Care | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | cancer | - |
dc.subject | insulin | - |
dc.subject | thiazolidinediones | - |
dc.subject | type 2 diabetes | - |
dc.title | DPP4i, thiazolidinediones, or insulin and risks of cancer in patients with type 2 diabetes mellitus on metformin–sulfonylurea dual therapy with inadequate control | - |
dc.type | Article | - |
dc.identifier.email | Wong, CKH: carlosho@hku.hk | - |
dc.identifier.email | Man, KCK: mkckth@hku.hk | - |
dc.identifier.email | Chan, EWY: ewchan@hku.hk | - |
dc.identifier.email | Tse, ETY: emilyht@hku.hk | - |
dc.identifier.email | Wong, ICK: wongick@hku.hk | - |
dc.identifier.email | Lam, CLK: clklam@hku.hk | - |
dc.identifier.authority | Wong, CKH=rp01931 | - |
dc.identifier.authority | Chan, EWY=rp01587 | - |
dc.identifier.authority | Tse, ETY=rp02382 | - |
dc.identifier.authority | Wong, ICK=rp01480 | - |
dc.identifier.authority | Lam, CLK=rp00350 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1136/bmjdrc-2020-001346 | - |
dc.identifier.pmid | 32532851 | - |
dc.identifier.pmcid | PMC7295418 | - |
dc.identifier.scopus | eid_2-s2.0-85086605388 | - |
dc.identifier.hkuros | 310448 | - |
dc.identifier.volume | 8 | - |
dc.identifier.issue | 1 | - |
dc.identifier.spage | article no. e001346 | - |
dc.identifier.epage | article no. e001346 | - |
dc.identifier.isi | WOS:000573913300008 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 2052-4897 | - |