Does diabetes therapy influence the risk of cancer?

Smith, Ulf; Gale, E. A. M.

doi:10.1007/s00125-009-1441-5

Cited by 300 publications

(277 citation statements)

References 53 publications

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“…In fact, previous authors have shown that insulin use may increase the risk of mortality 33. These findings allied to the risk of hypoglycemia 34 and suggestions that insulin might promote cardiovascular disease or cancers 35, 36, 37 have raised concerns regarding the safety of insulin for type 2 diabetes. However, conflicting evidence from an extended follow‐up of the trial with the biggest between‐group difference in insulin use revealed a 15% reduction in myocardial infarction and a 13% reduction in death among people with new‐onset type 2 diabetes 38.…”

Section: Discussionmentioning

confidence: 99%

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Noman

Balasubramaniam

Alhous

et al. 2016

Cathet Cardio Intervent

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ObjectivesTo assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency).BackgroundDM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI.MethodsRetrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011.ResultsAbout 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings.ConclusionIn the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Noman

Balasubramaniam

Alhous

et al. 2016

Cathet Cardio Intervent

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“…To have raised a scientific issue that can never be resolved, by using a flawed methodology, is unethical. In conclusion, probably the right and safe decision would have been to adopt the opinion of the three of the six referees who initially recommended rejection [61], and not publish the study by Hemkens et al, especially given that the Editorial accompanying the publication states: ‗There is no evidence of an overall increase in the rate of cancer development in patients on insulin glargine, and some suggestion that the risk may actually be reduced.' [61].…”

Section: The "Insulin Glargine Controversy"mentioning

confidence: 99%

“…In conclusion, probably the right and safe decision would have been to adopt the opinion of the three of the six referees who initially recommended rejection [61], and not publish the study by Hemkens et al, especially given that the Editorial accompanying the publication states: ‗There is no evidence of an overall increase in the rate of cancer development in patients on insulin glargine, and some suggestion that the risk may actually be reduced.' [61]. Unfortunately, the news of these results spread quickly, and troubled for a long time, probably forever, many diabetic patients who were using glargine insulin, often with great satisfaction, as well as their care providers.…”

Section: The "Insulin Glargine Controversy"mentioning

confidence: 99%

Diabetes mellitus, hyperglycaemia and cancer

Simon

Balkau

2010

Diabetes & Metabolism

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Epidemiology of diabetes, obesity and chronic kidney disease over the lifecourse. SummaryA moderate increase of cancer risk has been shown in diabetic patients and in subjects with abnormal glucose tolerance, mainly in digestive sites, independently of obesity, with on the contrary a protective effect for prostate cancer. Insulin-resistance with compensatory hyperinsulinemia, and elevated levels of circulating growth factors are usually considered as the link between cancer and hyperglycaemia, through activated cell proliferation. Antidiabetic treatments inducing elevated plasma insulin seem to increase cancer risk and, on the opposite, insulin-sensitizers antidiabetic drugs (metformine, thiazolidinediones) seem to reduce cancer risk. In 2009, a big fuss has been raised concerning a specific action of glargine insulin to increase cancer risk from an observational study in Germany accumulating methodological pitfalls, without any clear confirmation from other studies.Unexplained poor glycaemic control in known diabetic patients should lead to screen for a cancer, and diagnosis of cancer should not distract from appropriate management of diabetes care.Greater public awareness about healthy lifestyles (diet, physical activity) is needed to prevent these two major increasing Public Health issues, and in the meanwhile should reduce the frequency of obesity and cardiovascular diseases in the whole population.Keywords : type 2 diabetes, cancer, hyperinsulinemia, growth factors, epidemiology -3 - RésuméSauf pour la prostate, il existe un risque modérément accru de cancer, en particulier digestif,

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“…The accompanying editorial by Smith and Gale [6] gave an excellent assessment of these studies and the topic in question. Even though these studies implicated glargine, a larger and fundamentally more important question was whether insulin, endogenous or exogenous, could augment cancer risk in patients with diabetes.…”

Section: Merriam-webster Dictionary 11th Edition (1977)mentioning

confidence: 99%

Mitogenic action of insulin: friend, foe or ‘frenemy’?

Draznin

2009

Diabetologia

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Either endogenous or exogenous hyperinsulinaemia in the setting of insulin resistance promotes phosphorylation and activation of farnesyltransferase, a ubiquitous enzyme that farnesylates Ras proteins. Increased availability of farnesylated Ras at the plasma membrane enhances mitogenic responsiveness of cells to various growth factors, thus contributing to progression of cancer and atherosclerosis. This effect is specific to insulin, but is not related to the type of insulin used. The stimulatory effect of hyperinsulinaemia on farnesyltransferase in the presence of insulin resistance represents one potential mechanism responsible for mitogenicity and atherogenicity of insulin.

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Does diabetes therapy influence the risk of cancer?

Cited by 300 publications

References 53 publications

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Diabetes mellitus, hyperglycaemia and cancer

Mitogenic action of insulin: friend, foe or ‘frenemy’?

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