Insulin glargine and risk of cancer: a cohort study in the French National Healthcare Insurance Database

Aims/hypothesis Using the Echantillon Généraliste de Bénéficiaires: random 1/97 permanent sample of the French national healthcare insurance system database (EGB), we investigated whether, as previously suspected, the risk of cancer in insulin glargine (A21Gly,B31Arg,B32Arg human insulin) users is h...

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Bibliographic Details
Published in:Diabetologia 2012-03, Vol.55 (3), p.644-653
Main Authors: Blin, P., Lassalle, R., Dureau-Pournin, C., Ambrosino, B., Bernard, M. A., Abouelfath, A., Gin, H., Le Jeunne, C., Pariente, A., Droz, C., Moore, N.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Breast cancer
Cancer
Chronic illnesses
Cohort analysis
Cohort Studies
Databases, Factual
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - mortality
Diabetes. Impaired glucose tolerance
Disease
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
France - epidemiology
Health care
Human Physiology
Humans
Hypoglycemic Agents - adverse effects
Hypoglycemic Agents - therapeutic use
Incidence
Insulin
Insulin Glargine
Insulin, Long-Acting - adverse effects
Insulin, Long-Acting - therapeutic use
Insurance
Internal Medicine
Male
Medical sciences
Medicine
Medicine & Public Health
Metabolic Diseases
Metformin - adverse effects
Metformin - therapeutic use
Middle Aged
Mortality
National Health Programs
Neoplasms - chemically induced
Neoplasms - complications
Neoplasms - epidemiology
Patients
Risk
Sulfonylurea Compounds - adverse effects
Sulfonylurea Compounds - therapeutic use
Young Adult
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Summary:Aims/hypothesis Using the Echantillon Généraliste de Bénéficiaires: random 1/97 permanent sample of the French national healthcare insurance system database (EGB), we investigated whether, as previously suspected, the risk of cancer in insulin glargine (A21Gly,B31Arg,B32Arg human insulin) users is higher than in human insulin users. The investigation period was from 1 January 2003 to 30 June 2010. Methods We used Cox proportional hazards time-dependent models that were stratified on propensity score quartiles for use of insulin glargine vs human insulin, and adjusted for insulin, biguanide and sulfonylurea possession rates to assess the risk of cancer or death in all or incident exclusive or predominant (≥80% use time) users of insulin glargine compared with equivalent human insulin users. Results Only type 2 diabetic patients were studied. Exposure rates varied from 2,273 and 614 patient-years for incident exclusive users of insulin glargine or human insulin, respectively, to 3125 and 2341 patient-years for all patients predominantly using insulin glargine or human insulin, respectively. All-type cancer HRs with insulin glargine vs human insulin ranged from 0.59 (95% CI 0.28, 1.25) in incident exclusive users to 0.58 (95% CI 0.34, 1.01) in all predominant users. Cancer risk increased with exposure to insulin or sulfonylureas in these patients. Adjusted HRs for death or cancer associated with insulin glargine compared with human insulin ranged from 0.58 (95% CI 0.32, 1.06) to 0.56 (95% CI 0.36, 0.87). Conclusions/interpretation There was no excess risk of cancer in type 2 diabetic patients on insulin glargine alone compared with those on human insulin alone. The overall risk of death or cancer in patients on insulin glargine was about half that of patients on human insulin, thereby excluding a competitive risk bias.
ISSN:0012-186X
1432-0428
DOI:10.1007/s00125-011-2429-5