scholarly journals AB1088 NAIL PSORIASIS: THE UNDERESTIMATED DISORDER IN PSORIASIS AND PSORIASIS ARTHRITIS. CAN ULTRASOUND AND CAPILLARY MICROSCOPY IN PATIENTS WITH NAIL PSORIASIS SPEED UP OUR DIAGNOSIS AND THERAPY?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1833.2-1833
Author(s):  
B. C. Detlef ◽  
S. El-Nawab-Becker ◽  
M. Toellner ◽  
A. Kleinheinz ◽  
T. Witte
Keyword(s):  
Psoriasis Vulgaris ◽  
Extensor Tendon ◽  
Daily Practice ◽  
Daily Routine ◽  
Nail Psoriasis ◽  
Capillary Microscopy ◽  
Nail Matrix ◽  
Significant Difference ◽  
The Us ◽  
Nail Involvement

Background:Nail psoriasis is an extreme diagnostic and therapeutic challenge and represents an enormous physical and psychological burden for affected patients.50% of patients with psoriasis vulgaris develop nail involvement (NailPso)during the course of their disease. NailPso is the strongest predictor of psoriatic arthritis (PsA). Through the synovio-enthesial concept we have learned that there is an anatomical-pathophysiological relationship between DIP joint, extensor tendon and nail matrix. We have observed in daily practice that hypervascularization (HV) in ultrasound Power Doppler (US-PD)the nail matrix may be a pathognomonic element in its own right. There are no data on this in the literature.Objectives:Is there a difference in the ultrasound PD examination of the DIP joint and nail area and in the capillary microscopy of the corresponding nail fold in patients with psoriasis vulgaris and nail psoriasis versus patients with psoriasis vulgaris without nail psoriasis.Methods:Monocentric prospective study of all consecutive patients with psoriasis vulgaris who have come to a rheumatic practice to clarify a PsA. Inaddition to demographic data, assessments (PASI,DLQI,CASPAR,GEPARD, DAS28, SJ,TJ,FFBH), clinical examination, a standardized ultrasound PD examination and capillary microscopy of the affected fingertips in PsO patients suffering from nail psoriasis was performed as well as corresponding examinations of the 2nd and 3rd finger right in PsO patients without nail involvement.Results:79 patients could be included during the study period. Thereof 25 PsO patients without nail involvement and 44 PsO patients with nail involvement. Since the patients were examined consecutively, the difference results. There was no difference in age, BMI and sex in both groups (Pso and NailPso). The Caspar criteria as classification criteria for a PsA were positive in 65% of the NailPso patients and positive in 50% of all PsO patients without nail infestation. Hypervascularization in the US-PD examination in the area of the nail matrix could be seen significantly more frequently in NailPso compared to non-NagelPso patients. Such a difference did not exist in the HV of the extensor tendons.Capillary microscopy showed a significant difference in the number of torsions/twist capillaries in NailPso compared to Pso patients without NailPso.Hypervascularization of the nail matrix is seen significantly more frequently in patients with psoriasis of the nail than in patients without psoriasis of the nail. Such a difference does not exist in DIP joint -extensor tendon- enthesitis. At the same time, torsions are significantly more frequently seen in capillary microscopy in NailPso than in patients without NailPso.Conclusion:The US-PD examination is a simple and non-invasive procedure which can be performed routinely in daily practice. The hypervascularization of the nail matrix should also make one think of nail psoriasis in the early stage of PsO, in order to be able to start early an appropriate therapy for this very stigmatizing and therapeutically extremely difficult manifestation of PsO. It seems to occur independently of extensor tendon synovitis as an independent manifestation phenomenon.The occurrence of torsions in capillary microscopy >50 % also seems to be groundbreaking for a NagelPso, whereby capillary microscopy is a temporal challenge in daily routine.References:§ The present study (7734-BO-S2018 Ethics Commission of the MHH, Medical School Hannover, Germany) contains parts of the PhD thesis of M.TöllnerDisclosure of Interests:Becker-Capeller Detlef Grant/research support from: Novartis, Speakers bureau: Pfizer, Soham El-Nawab-Becker: None declared, Malo Toellner: None declared, Andreas Kleinheinz: None declared, Torsten Witte: None declared

scholarly journals Treatment with intralesional methotrexate injection in a patient with nail psoriasis

2022 ◽  
Vol 13 (1) ◽  
pp. 62-64
Author(s):  
Yesim Akpinar Kara
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Topical Treatment ◽  
Psoriasis Vulgaris ◽  
Corticosteroid Injection ◽  
Inflammatory Skin Disease ◽  
Nail Psoriasis ◽  
Nail Involvement ◽  
Systemic Therapies

Psoriasis vulgaris is an inflammatory skin disease involving the skin, nails, and joints. While nail involvement is observed in 70–80% of patients with psoriasis, the rate of patients with isolated nail involvement is 5–10%. Dystrophies arising in the nails in psoriasis affect the patient’s quality of life, and local and systemic therapies may be used as treatment. Intralesional methotrexate or corticosteroid injection might be an option in the treatment of patients with the involvement of one nail or some nails or without the involvement of the skin and joints, due to the side effects of systemic and biological agents. Herein, we report a female patient with nail psoriasis resistant to a previously applied topical treatment, the efficacy of intralesional methotrexate without the use of a systemic antipsoriatic agent, and no progression of side effects.

General surgical foundation doctor: optimisation of daily practice

2020 ◽  
Vol 96 (1136) ◽  
pp. 339-342
Author(s):  
Emmanuel Feldano ◽  
Michael Clark ◽  
Benjamin Ramasubbu
Keyword(s):  
Structural Changes ◽  
Positive Impact ◽  
Daily Practice ◽  
Daily Routine ◽  
Improvement Project ◽  
Surgical Ward ◽  
Significant Difference ◽  
Working Day ◽  
And Performance

IntroductionThe role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes.MethodsThe project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s on wards observing daily routine (arrival, lunch and departure time), communication and handovers. Following this a number of interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in week 2 (as the new model was scaffolded into place) and week 3 (strictly observed).ResultsThere was no significant difference in number of tasks between week 1, 2 and 3. In week 1, there was no set times for lunch, all of the FY1s lunches were interrupted, there was no structure for handovers and 100% of FY1s stayed at work beyond there contracted hours. In week 2 and 3 there was significant improvement in the number of uninterrupted lunches, amount of time spent beyond contracted hours, number and quality of handovers. The qualitative results collected also suggested positive impact on the working lives of those involved.ConclusionThe implementation of structural changes improved the quality of FY1s working day and increased the efficiency of service delivered on the surgical ward.

scholarly journals 8 General surgical foundation doctor optimisation of daily practice

2019 ◽  
Vol 95 (1130) ◽  
pp. 687.1-687
Author(s):  
Emmanuel Feldano ◽  
Ben Ramasubbu
Keyword(s):  
Structural Changes ◽  
Working Hours ◽  
Daily Practice ◽  
Task Completion ◽  
Junior Doctors ◽  
Daily Routine ◽  
European Working ◽  
Significant Difference ◽  
Working Day ◽  
And Performance

IntroductionTraditionally the role of a surgical foundation year 1 (FY1s) doctors consisted of long working hours, multiple on call shifts and little to rest however, the introduction of European working time directive now means that FY1s are constricted to 48 hours per week on average and various other regulations that junior doctors should abide by yet the same quantity of daily tasks remains the same. In this study we looked at the difficulties FY1s now face in their daily working day and if some of these issues could be resolved by implementing some structural changes.MethodsThe study was conducted in three cycles, each lasting five days (Monday to Friday). Cycle 1 included shadowing of Surgical FY1s on wards for five consecutive days observing daily routine (arrival, lunch and departure time), task completion, communication and handovers. Following this multiple interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in cycle 2 (as the new model was scaffolded into place) and cycle 3 (strictly observed).ResultsIn cycle 1 we observed that 100% of F1s arrived to work on time, there was no set times for lunch and all of the FY1s lunches were interrupted. There was no structure for handovers and 100% of F1s stayed at work beyond there contracted hours. In second cycle, 100% of F1s had lunch between the hours of 12pm-1PM on 3/5 days and 75% on the remaining two days. 75% of F1s had uninterrupted lunches on all 5 days. Morning and afternoon handovers were completed every day. In cycle 3 the results remained as high. There was no significant difference in number of tasks between week 1, 2 and 3.ConclusionThrough the implementation of daily structure and other interventions involving the multidisciplinary team we improved the quality of F1s working day and increased the efficiency of service delivered on the surgical ward.

AB0796 PSORIATIC ONYCHOPATHY: MORE THAN MEETS THE EYE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1698.1-1698
Author(s):  
I. Mahmoud ◽  
S. Rahmouni ◽  
A. Ben Tekaya ◽  
S. Bouden ◽  
R. Tekaya ◽  
...  
Keyword(s):  
Plate Thickness ◽  
Nail Plate ◽  
Assessment Tools ◽  
Moderate Activity ◽  
Nail Matrix ◽  
The Us ◽  
Matrix Region ◽  
The Mean ◽  
Nail Disease ◽  
Nail Involvement

Background:Psoriatic onychopathy is an independent predictor of the onset of psoriatic arthritis (PsA). Assessment of nail disease is difficult given the limited utility of clinical assessment tools for the nail.Recently, ultrasound (US) proved to be informative in the assessment of nail involvement.Objectives:We aimed to describe morphologic ultrasonographic nail disease changes and to look for correlations between these features and the characteristics of the PsA.Methods:The study included patients who met the CASPAR criteria for PsA.An US scan of patient’s nails was performed in order to study the nail, matrix and skin thickness.Results:We included 33 patients with PsA with a mean age of 51.2±12.5 years. The mean DAPSA was 22.8±19.7 (remission:9 patients, low activity: 5 patients, moderate activity: 11 patients and high activity: 8 patients).Twenty-nine patients had a personal history of skin psoriasis, present in 64 % of the patients the day of the examination with a mean PASI of 2.76 ±3.9.Eleven patients (33.4%) presented with psoriatic onychopathy (45 fingernails) with a mean mNAPSI of 14.1± 16.The most common patterns of nail involvement were:Oil-drop patches (5 fingernails), pitting (4 fingernails), onycholysis (3 fingernails), crumbling (3 fingernails), subungual hyperkeratosis (2 fingernails), leukonychia (2 fingernails),paronychia(2 fingernails), splinter hemorrhages (1 fingernail).We scanned 330 fingernails. The US study revealed dystrophy in 75 nails (22.7%) of the nails, in 17 patients (51.5%): Undulations or pitting (n=47), followed by disappearance of the anechoic space (n=38) and anechoic ventral nail plate (n=18).The mean thickness of skin, nail plate and nail matrix region were 2.25±0.32 mm, 0.38±0.07 mm and 1.89±0.33, respectively.We found a positive correlation between nail plate thickness and both skin and nail matrix region thickness (r=0.561, p=0.001 and r=0.523, p=0.002).Skin, nail and nail matrix thickness were significantly higher in men and in smokers. Manual workers did not have greater skin, nail plate nor nail matrix thickness.There were no correlations between disease activity evaluated by the ASDAS-CRP, DAS28, PASI, ESR or by CRP and any of the US parameters.In contrast, there was a significant negative correlation between psoriatic disease duration and nail plate thickness (r=-0.372, p=0,036).Conclusion:Ultrasound offers an appropriate alternative for the evaluation of the nail unit. In our study it was able to detect subclinical involvement of the nail in 30 fingernails and in two patients.Disclosure of Interests:None declared

scholarly journals Nd:YAG Laser in the Treatment of Nail Psoriasis: Clinical and Dermoscopic Assessment

2021 ◽  
pp. e2021140
Author(s):  
Yasmin Hesham Ali Elwan ◽  
Amira Azim ◽  
Michela Starace ◽  
Hala Shawky Abd Elhafiz
Keyword(s):  
Nd:Yag Laser ◽  
Treated Group ◽  
Small Sample ◽  
Mean Difference ◽  
Controlled Study ◽  
Control Group ◽  
Beam Diameter ◽  
Nail Psoriasis ◽  
Nail Matrix ◽  
Significant Difference

Background: The Nd:YAG laser has emerged as a promising modality for the management of nail psoriasis owing to its ability for deep penetration of the skin surface, which has the advantage of destroying deep vessels. Objective: To assess the efficacy and safety of Nd:YAG laser in treating nail psoriasis. Methods: The present study was a randomized controlled study, conducted on 20 patients of both sexes (age older than 12 years) with mild to moderate psoriasis with nail involvement. We utilized facial telangiectasia parameters of Nd:YAG laser and beam diameter of 2.5 mm. Laser energy started with 110 J/cm2 in the first session and 130 J/cm2 in the rest of the sessions. Sessions were performed once monthly for up to 6 sessions. Results: We found no statistically significant difference in total Nail Psoriasis Severity Index (NAPSI) and nail bed scores before and after treatment among the treated group. However, there was statistically significant improvement in nail matrix score after treatment. On the other hand, the control group did not show any statistically significant changes for all scores throughout the study, except for the nail matrix score mean difference (0.35 ± 1.23 vs -1.00 ± 1.86 in the treated group). The degree of dermoscopic improvement was evident in the treated group (45% vs 25% in the control group). However, it was not statistically significant because of small sample size. The patients’ satisfaction and the external investigator’s assessment showed statistically significant negative correlation with total NAPSI mean difference in the treated group. Conclusion: The role of Nd:YAG laser in nail psoriasis is still controversial.

scholarly journals Bioelectric Effect of a Microcurrent Toothbrush on Plaque Removal

2021 ◽  
Vol 18 (16) ◽  
pp. 8255
Author(s):  
Ji-Hyun Lee ◽  
Jin-Hee Ha
Keyword(s):  
Bacterial Flora ◽  
Gingival Index ◽  
Direct Electric Current ◽  
Plaque Removal ◽  
Bioelectric Effect ◽  
Biofilm Removal ◽  
Significant Difference ◽  
The Us ◽  
Before And After ◽  
Previous State

This study evaluated the effectiveness of a microcurrent toothbrush (approved by the US Food and Drug Administration [FDA]), which employs a superimposed alternating and direct electric current, named as a Proxywave® technology, similar to the intensity of the biocurrent, in plaque removal and reducing gingivitis by biofilm removal through the bioelectric effect. This study enrolled 40 volunteers with gingivitis. Dental observations were made every two weeks, before and after the use of each toothbrush. We randomly assigned participants into two groups: one group used the Proxywave® toothbrush (PB) for two weeks followed by the control toothbrush (CB) for two weeks, while the other group used the CB for two weeks followed by the PB. The participants had a two-week washout period. If the toothbrush used earlier has had an effect on the bacterial flora in the oral cavity, this is to remove this effect and return it to its previous state. During each dental visit, we recorded plaque index (PI) and gingival index (GI) scores. The PI and GI scores were significantly lower in both the PB and the CB (p < 0.05). Considering the PI, there was no significant difference between the toothbrushes on all the surfaces. Considering the GI, the PB showed a significant decrease in the interproximal surface, compared to the CB (p < 0.05). The PB showed a significant decrease in the interproximal GI and had a beneficial effect in the interproximal area where the bristles could not reach. No adverse events were observed in the participants during the clinical trial. The microcurrent toothbrush is a device that can be safely used for plaque removal.

scholarly journals Assessing the Attitude of Tampa Bay Youth toward HIV Self-Testing Kits

2021 ◽  
Vol 6 (3) ◽  
pp. 111
Author(s):  
Sherry Zhang ◽  
Isabella Lopez ◽  
Bernard Washington ◽  
Brittney Gaudet ◽  
Carina A. Rodriguez ◽  
...  
Keyword(s):  
Tampa Bay ◽  
Hiv Status ◽  
Health Clinics ◽  
Home Testing ◽  
Self Testing ◽  
Significant Difference ◽  
The Us ◽  
Study Population ◽  
Location Study ◽  
Sexual Health Clinics

In adults, data support the utility and acceptance of home HIV testing; however, in youth, particularly in the US, this has not been well studied. In this exploratory study, we surveyed Tampa Bay youth aged 16−27 and attending sexual health clinics between 1 June and 31 June 2018 (n = 133) regarding attitudes and perceptions towards HIV self-testing. While most indicated the clinic over home when asked for preferred testing location, study population and subgroup analysis demonstrated a positive response (agree) to Likert-scale questions regarding the use of home HIV self-testing kits and negative responses (strongly disagree) to “would not use self-testing kit”. There was a significant difference between genders in testing location preference (p = 0.031) for those respondents that specified gender (n = 123), with males more likely to prefer home testing than females. This study suggests an openness of youth towards HIV home testing that could help to expand the number of youth aware of their HIV status.

scholarly journals AB0115 COMPARISON OF ULTRASOUND FINDINGS BETWEEN TNF INHIBITORS AND NON-TNF INHIBITORS AT FIRST BIOLOGICS IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1086.2-1087
Author(s):  
T. Okano ◽  
T. Koike ◽  
K. Inui ◽  
K. Mamoto ◽  
Y. Yamada ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Duration ◽  
Power Doppler ◽  
Tnf Inhibitors ◽  
Tnf Inhibitor ◽  
Significant Difference ◽  
The Us ◽  
Us Findings ◽  
Improvement Ratio

Background:In rheumatoid arthritis (RA), biologics treatment is one of the effective treatment options. Usually, there is no difference in therapeutic effect regardless of which biologics is used, but the effect for joint synovitis is unknown. Recently, ultrasound (US) has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA.Objectives:The aim of this study was to compare the improvement of US findings between TNF inhibitors and non-TNF inhibitors at first biologics in patients with RA.Methods:Fifty-four RA patients who started the first biologics from September 2016 to December 2018 were included in this longitudinal study (SPEEDY study, UMIN000028260). All the patients were performed clinical examination, blood test and US examination at baseline, 4, 12, 24, 36 and 52 weeks. A US examination was performed at the bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three part of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints, by using HI VISION Ascendus (Hitachi Medical Corporation, Japan) with a multifrequency linear transducer (18-6 MHz). The gray scale (GS) and power Doppler (PD) findings were assessed by the semi-quantitative method (0-3). GS score and PD score (both 0-108 points) were defined as the sum of each score. The change of disease activity and US findings were compared between TNF group and non-TNF group.Results:Among 54 cases, 32 patients were used TNF inhibitor and 22 were non-TNF inhibitor. Age and duration of RA were significantly higher in the non-TNF group, and MTX dose was significantly lower in the non-TNF group. The baseline inflammatory markers tended to be higher in the non-TNF group and the disease activity was also higher in the non-TNF group. However, the US findings showed no significant difference in both GS and PD between two groups at baseline. US improvement ratio was no difference between TNF group and non-TNF group at 4, 12, 24, 36 and 52 weeks in both GS and PD score. Regardless of the type of biologics, patients with long-term disease duration tended to have poor improvement in US synovial fingings.Table 1.Baseline patient and disease characteristicsTNF (n=32)non-TNF (n=22)P valueFemale patients, n (%)21 (65.6)16 (72.7)0.767Age (years)63.5±15.471.0±9.00.030Disease duration (years)6.5±8.213.0±11.70.032CRP (mg/dl)1.8±2.53.0±3.20.170DAS28-ESR5.0±1.45.8±1.20.022GS score26.1±18.831.8±21.10.313PD score17.6±11.423.1±14.60.150Figure 1.GS and PD improvement ratio at 4, 12, 24, 36 and 52 weeksConclusion:There was no difference in the US findings improvement between patients with TNF inhibitor and non-TNF inhibitor at first biologics in patients with RA.References:[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.[2]Nishino A, Kawashiri SY, Koga T, et al. Ultrasonographic Efficacy of Biologic andTargeted Synthetic Disease-ModifyingAntirheumatic Drug Therapy in RheumatoidArthritis From a Multicenter RheumatoidArthritis Ultrasound Prospective Cohort in Japan. Arthritis Care Res (Hoboken). 2018;70:1719-26.Acknowledgements:We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka for clinical assistant, Setsuko Takeda, Emi Yamashita, Yuko Yoshida, Rika Morinaka, Hatsue Ueda and Tomomi Iwahashi for their special efforts as a sonographer and collecting data.Disclosure of Interests:None declared

scholarly journals Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis

2021 ◽  
Vol 10 (10) ◽  
pp. 2122
Author(s):  
Magdalena Krajewska-Włodarczyk ◽  
Zbigniew Żuber ◽  
Agnieszka Owczarczyk-Saczonek
Keyword(s):  
Morphological Changes ◽  
Nail Plate ◽  
Clinical Signs ◽  
Extensor Tendon ◽  
Control Group ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Ultrasound Evaluation ◽  
Tendon Thickness ◽  
Retinoid Treatment

The study aimed to evaluate the effect of retinoid treatment on the morphological changes in the nail apparatus in patients with nail psoriasis. Material and methods: 41 patients aged 32 to 64 with nail psoriasis, without clinical signs of psoriatic arthritis, started on acitretin 0.6 to 0.8 mg kg b.w./d, for six months and 28 people in the control group were included in the study. Both groups had ultrasound examination of fingernails and digital extensor tendon in the distal interphalangeal joints. In psoriatic patients, US examination was conducted before starting the treatment and after six months. A total of 685 nails were examined. Results: After six months of treatment, there was a reduction in the thickness of the nail bed and nail matrix (p = 0.046 and p = 0.031, respectively). The thickness of the nail plates decreased, although it was statistically insignificant (p = 0.059) and it was higher than in the control group (p = 0.034). The reduced severity of clinical nail changes after six months of retinoid treatment did not correlate with the reduction in extensor tendon thickness in any group of patients. Conclusions: In patients with nail psoriasis, acitretin treatment resulted in a rapid decrease in the thickness of the nail bed and matrix, but it did not affect the thickness of the nail plate after six months. There was no effect of acitretin on the digital extensor tendon thickness or the increased blood supply to the tendon area. The results of the study may indicate the usefulness of ultrasound nail examinations in patients with nail psoriasis not only to assess the advancement of morphological changes and response to treatment, but also to choose the potential treatment.

Insulin Glargine and Risk of Cancer: A Meta-Analysis

2012 ◽  
Vol 27 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Xinli Du ◽  
Rihua Zhang ◽  
Yi Xue ◽  
Dong Li ◽  
Jinmei Cai ◽  
...  
Keyword(s):  
Insulin Glargine ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Long Term Effects ◽  
Open Label ◽  
Cancer Occurrence ◽  
Pubmed Database ◽  
Significant Difference ◽  
The Us ◽  
Risk Of Cancer

Aims Recently, more and more attention has been drawn on the long-term effects of insulin glargine. Here we strived to estimate the association of cancer occurrence with the use of insulin glargine. Methods We searched all the publications regarding the association between cancer occurrence and the use of insulin glargine using the US National Library of Medicine's PubMed database. Data were independently extracted and analyzed using random or fixed effects meta-analysis depending upon the degree of heterogeneity. Results Seven cohort studies were included in the meta-analysis. Cancer occurrence had no significant difference in glargine-treated patients compared to patients treated with other insulins (RR=0.86, 95% CI=0.69–1.07, p=0.17, Pheterogeneity <0.00001). In our subgroup analysis, glargine, compared to other insulins, did not increase the risk of breast cancer (RR=1.14, 95% CI=0.65–2.02, p=0.65, Pheterogeneity=0.002), prostate cancer (RR=1.00, 95% CI=0.79–1.26, p=0.99, Pheterogeneity=0.78), pancreatic cancer (RR=0.57, 95% CI=0.14–2.35, p=0.44, Pheterogeneity=0.0002) and gastrointestinal cancer (RR=0.80, heterogeneity 95% CI=0.62–1.02, p=0.07, Pheterogeneity=0.86). Conclusions This meta-analysis of open-label studies does not support an increased cancer risk in patients treated with insulin glargine. The result provides confidence for the development of insulin glargine, but needs confirmation by further clinical studies.

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