The Use of Long-Acting Insulin Analogs and the Risk of Colorectal Cancer Among Patients with Type 2 Diabetes: A Population-Based Cohort Study

Abstract Background: Little is known about the comparative vascular safety of basal insulin (intermediate-acting human insulin [IAHI] or long-acting insulin analogue [LAIA]) in type 2 diabetes. We sought to examine the vascular and hypoglycemic effects associated with IAHI versus LAIA in real-world patients with type 2 diabetes. Methods: We conducted a nationwide population-based, retrospective cohort study using Taiwan’s National Health Insurance Research Database to include patients with type 2 diabetes who stably used an IAHI (N=11,521) or LAIA (N=37,651) in the period 2004-2012. A rigorous three-step matching algorithm that considered the initiation date of basal insulin, previous exposure of antidiabetic treatments, comorbidities, diabetes severity and complications, and concomitant medications was applied to achieve the between-group comparability. Study outcomes, including composite cardiovascular diseases (CVDs), composite microvascular diseases (MVDs), and hypoglycemia, were assessed up to the end of 2013. Results: Baseline patient characteristics were balanced with the application of the matching scheme. Compared with LAIA, the use of IAHI was associated with greater risks of composite CVDs (adjusted hazard ratio: 1,79; 95% confidence interval: 1.20-2.67) and hospitalized hypoglycemia (1.82; 1.51-2.20), but a lower risk of composite MVDs (0.88; 0.84-0.91). Subgroup and sensitivity analyses showed a consistent trend of results with that in the primary analyses. Conclusions: The use of a basal insulin with IAHI versus LAIA among patients with type 2 diabetes in usual practice may be associated with a lower risk of MVDs, and strategies should be optimized for minimizing the risks of hypoglycemia and CVDs in this population.

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Retrospective cohort study evaluating exenatide twice daily and long-acting insulin analogs in a Veterans Health Administration population with type 2 diabetes

Diabetes & Metabolism ◽

10.1016/j.diabet.2014.06.002 ◽

2014 ◽

Vol 40 (4) ◽

pp. 284-291 ◽

Cited By ~ 6

Author(s):

M. Bounthavong ◽

J.N. Tran ◽

S. Golshan ◽

N.F. Piland ◽

C.M. Morello ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Retrospective Cohort ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Insulin Analogs ◽

Acting Insulin ◽

Long Acting

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115 RISK OF POST-COLONOSCOPY COLORECTAL CANCER IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A DANISH POPULATION-BASED COHORT STUDY

Gastroenterology ◽

10.1016/s0016-5085(21)00818-0 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-30

Author(s):

Frederikke Sch⊘nfeldt Troelsen ◽

Henrik Toft S⊘rensen ◽

Lars Pedersen ◽

Rune Erichsen

Keyword(s):

Diabetes Mellitus ◽

Colorectal Cancer ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cohort Study ◽

Population Based ◽

Danish Population

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Insulin enhances and metformin reduces risk of colorectal carcinoma in type-2 diabetes

QJM ◽

10.1093/qjmed/hcz253 ◽

2019 ◽

Author(s):

C-H Chen ◽

C-L Lin ◽

C-Y Hsu ◽

C-H Kao

Keyword(s):

Colorectal Cancer ◽

Type 2 Diabetes ◽

Cohort Study ◽

Dietary Habits ◽

Occult Blood ◽

Population Based ◽

Study Cohort ◽

Urbanization Level ◽

Increased Risk

Abstract Background Identifying colorectal cancer associated risks is important for conducting a program for the survey and prevention of colorectal cancer. Aim To investigate the association between use of insulin or metformin with colorectal cancer (CRC) in type 2 diabetes (T2DM). Design Population-based cohort study. Methods Through analysis of National Health Insurance (NHI) database between 1998 and 2010 in Taiwan, we identified 66 324 T2DM patients aged ≥ 20 years and selected subjects without diabetes by 1: 1 randomly matching with the study cohort based on age, sex and index date. We followed up the participants until 31 December 2011 or when they withdrew from the NHI program. Results Compared with non-diabetic subjects, the T2DM patients exhibited an increased risk of CRC [adjusted HR (aHR) = 1.56, 95% confidence interval (CI) = 1.39–1.75], after adjustment for age, sex, urbanization level, comorbidities and examinations of colonoscopy, sigmoidoscopy, or stool occult blood test. Among the T2DM patients, insulin usage increased the risk of CRC (aHR = 1.86, 95% CI = 1.58–0–2.19) after adjustment for age, sex, urbanization level, comorbidities, metformin usage and examinations; nevertheless, metformin decreased the risk of CRC (aHR = 0.65, 95% CI = 0.54–0.77) after adjustment for age, sex, urbanization level, comorbidities, insulin usage and examinations. Compared with the non-insulin cohort, the risk of CRC tended to increase with the incremental dosage of insulin exposure. Conclusion Our population-based cohort study demonstrated an association between T2DM and CRC. Among the T2DM patients, insulin use was associated with an increased risk of CRC and metformin use was associated with a decreased risk of CRC. Inability to obtain information on several potential confounding factors, such as lifestyle and dietary habits, is the major limitation of the study.

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