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Incidence of malignancies in patients with diabetes mellitus and correlation with treatment modalities in a large Israeli health maintenance organization: a historical cohort study.

Abstract It has been hypothesized that incidence of and mortality from several malignancies are increased among diabetic patients. Whether certain treatment modalities, including use of metformin, sulfonylureas, or insulins, affect cancer incidence or mortality and whether use of long-acting insulin analogues glargine and detemir may increase cancer incidence more than traditional human insulins are debated. The objective was to investigate the association between specific glucose-lowering agents and cancer incidence in diabetic members of an Israeli health maintenance organization. We studied a cohort of 36,342 diabetic patients aged at least 18 years with no history of cancer or treatment with insulin as of January 1, 2003. For the period from January 2003 to December 2007, we searched pharmacy records for purchases of glucose-lowering agents, including metformin, sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses were identified from the health maintenance organization cancer registry. We studied the association of cancer incidence with the use of specific glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin measurement. Cancer was diagnosed in 6% of the study cohort during 164,652 person-years of follow-up time. Cancer incidence increased with age and varied with medication purchasing patterns. On multivariate analysis, age (hazard ratio [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI, 1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were significantly associated with increased cancer risk, whereas number of metformin purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998). Male sex, age, and human insulin purchases were associated with increased cancer incidence, whereas metformin purchases were associated with decreased cancer risk. There was a trend for increased cancer incidence associated with use of long-acting insulin analogues, but the number of long-acting insulin analogue users was too small for risk estimates to be conclusive.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title metabolism: clinical and experimental
Publication Year Start
%A Buchs, Andreas E.; Silverman, Barbara G.
%T Incidence of malignancies in patients with diabetes mellitus and correlation with treatment modalities in a large Israeli health maintenance organization: a historical cohort study.
%J Metabolism: clinical and experimental, vol. 60, no. 10, pp. 1379-1385
%D 10/2011
%V 60
%N 10
%M eng
%B It has been hypothesized that incidence of and mortality from several malignancies are increased among diabetic patients. Whether certain treatment modalities, including use of metformin, sulfonylureas, or insulins, affect cancer incidence or mortality and whether use of long-acting insulin analogues glargine and detemir may increase cancer incidence more than traditional human insulins are debated. The objective was to investigate the association between specific glucose-lowering agents and cancer incidence in diabetic members of an Israeli health maintenance organization. We studied a cohort of 36,342 diabetic patients aged at least 18 years with no history of cancer or treatment with insulin as of January 1, 2003. For the period from January 2003 to December 2007, we searched pharmacy records for purchases of glucose-lowering agents, including metformin, sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses were identified from the health maintenance organization cancer registry. We studied the association of cancer incidence with the use of specific glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin measurement. Cancer was diagnosed in 6% of the study cohort during 164,652 person-years of follow-up time. Cancer incidence increased with age and varied with medication purchasing patterns. On multivariate analysis, age (hazard ratio [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI, 1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were significantly associated with increased cancer risk, whereas number of metformin purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998). Male sex, age, and human insulin purchases were associated with increased cancer incidence, whereas metformin purchases were associated with decreased cancer risk. There was a trend for increased cancer incidence associated with use of long-acting insulin analogues, but the number of long-acting insulin analogue users was too small for risk estimates to be conclusive.
%K Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Cohort Studies, Diabetes Complications, Diabetes Mellitus, Female, Health Maintenance Organizations, Humans, Hypoglycemic Agents, Incidence, Israel, Male, Middle Aged, Neoplasms, Sample Size, Young Adult
%P 1379
%L 1385
%Y 10.1016/j.metabol.2011.05.002
%W PHY
%G AUTHOR
%R 2011.......60.1379B

@Article{Buchs2011,
author="Buchs, Andreas E.
and Silverman, Barbara G.",
title="Incidence of malignancies in patients with diabetes mellitus and correlation with treatment modalities in a large Israeli health maintenance organization: a historical cohort study.",
journal="Metabolism: clinical and experimental",
year="2011",
month="Oct",
day="21",
volume="60",
number="10",
pages="1379--1385",
keywords="Adolescent",
keywords="Adult",
keywords="Aged",
keywords="Aged, 80 and over",
keywords="Algorithms",
keywords="Cohort Studies",
keywords="Diabetes Complications",
keywords="Diabetes Mellitus",
keywords="Female",
keywords="Health Maintenance Organizations",
keywords="Humans",
keywords="Hypoglycemic Agents",
keywords="Incidence",
keywords="Israel",
keywords="Male",
keywords="Middle Aged",
keywords="Neoplasms",
keywords="Sample Size",
keywords="Young Adult",
abstract="It has been hypothesized that incidence of and mortality from several malignancies are increased among diabetic patients. Whether certain treatment modalities, including use of metformin, sulfonylureas, or insulins, affect cancer incidence or mortality and whether use of long-acting insulin analogues glargine and detemir may increase cancer incidence more than traditional human insulins are debated. The objective was to investigate the association between specific glucose-lowering agents and cancer incidence in diabetic members of an Israeli health maintenance organization. We studied a cohort of 36,342 diabetic patients aged at least 18 years with no history of cancer or treatment with insulin as of January 1, 2003. For the period from January 2003 to December 2007, we searched pharmacy records for purchases of glucose-lowering agents, including metformin, sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses were identified from the health maintenance organization cancer registry. We studied the association of cancer incidence with the use of specific glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin measurement. Cancer was diagnosed in 6\% of the study cohort during 164,652 person-years of follow-up time. Cancer incidence increased with age and varied with medication purchasing patterns. On multivariate analysis, age (hazard ratio [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI, 1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were significantly associated with increased cancer risk, whereas number of metformin purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998). Male sex, age, and human insulin purchases were associated with increased cancer incidence, whereas metformin purchases were associated with decreased cancer risk. There was a trend for increased cancer incidence associated with use of long-acting insulin analogues, but the number of long-acting insulin analogue users was too small for risk estimates to be conclusive.",
issn="1532-8600",
doi="10.1016/j.metabol.2011.05.002",
url="http://www.ncbi.nlm.nih.gov/pubmed/21696791",
language="eng"
}

%0 Journal Article
%T Incidence of malignancies in patients with diabetes mellitus and correlation with treatment modalities in a large Israeli health maintenance organization: a historical cohort study.
%A Buchs, Andreas E.
%A Silverman, Barbara G.
%J Metabolism: clinical and experimental
%D 2011
%8 Oct 21
%V 60
%N 10
%@ 1532-8600
%G eng
%F Buchs2011
%X It has been hypothesized that incidence of and mortality from several malignancies are increased among diabetic patients. Whether certain treatment modalities, including use of metformin, sulfonylureas, or insulins, affect cancer incidence or mortality and whether use of long-acting insulin analogues glargine and detemir may increase cancer incidence more than traditional human insulins are debated. The objective was to investigate the association between specific glucose-lowering agents and cancer incidence in diabetic members of an Israeli health maintenance organization. We studied a cohort of 36,342 diabetic patients aged at least 18 years with no history of cancer or treatment with insulin as of January 1, 2003. For the period from January 2003 to December 2007, we searched pharmacy records for purchases of glucose-lowering agents, including metformin, sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses were identified from the health maintenance organization cancer registry. We studied the association of cancer incidence with the use of specific glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin measurement. Cancer was diagnosed in 6% of the study cohort during 164,652 person-years of follow-up time. Cancer incidence increased with age and varied with medication purchasing patterns. On multivariate analysis, age (hazard ratio [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI, 1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were significantly associated with increased cancer risk, whereas number of metformin purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998). Male sex, age, and human insulin purchases were associated with increased cancer incidence, whereas metformin purchases were associated with decreased cancer risk. There was a trend for increased cancer incidence associated with use of long-acting insulin analogues, but the number of long-acting insulin analogue users was too small for risk estimates to be conclusive.
%K Adolescent
%K Adult
%K Aged
%K Aged, 80 and over
%K Algorithms
%K Cohort Studies
%K Diabetes Complications
%K Diabetes Mellitus
%K Female
%K Health Maintenance Organizations
%K Humans
%K Hypoglycemic Agents
%K Incidence
%K Israel
%K Male
%K Middle Aged
%K Neoplasms
%K Sample Size
%K Young Adult
%U http://dx.doi.org/10.1016/j.metabol.2011.05.002
%U http://www.ncbi.nlm.nih.gov/pubmed/21696791
%P 1379-1385

PT Journal
AU Buchs, AE
   Silverman, BG
TI Incidence of malignancies in patients with diabetes mellitus and correlation with treatment modalities in a large Israeli health maintenance organization: a historical cohort study.
SO Metabolism: clinical and experimental
JI Metab. Clin. Exp.
PD Oct
PY 2011
BP 1379
EP 1385
VL 60
IS 10
DI 10.1016/j.metabol.2011.05.002
LA eng
DE Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Cohort Studies; Diabetes Complications; Diabetes Mellitus; Female; Health Maintenance Organizations; Humans; Hypoglycemic Agents; Incidence; Israel; Male; Middle Aged; Neoplasms; Sample Size; Young Adult
AB It has been hypothesized that incidence of and mortality from several malignancies are increased among diabetic patients. Whether certain treatment modalities, including use of metformin, sulfonylureas, or insulins, affect cancer incidence or mortality and whether use of long-acting insulin analogues glargine and detemir may increase cancer incidence more than traditional human insulins are debated. The objective was to investigate the association between specific glucose-lowering agents and cancer incidence in diabetic members of an Israeli health maintenance organization. We studied a cohort of 36,342 diabetic patients aged at least 18 years with no history of cancer or treatment with insulin as of January 1, 2003. For the period from January 2003 to December 2007, we searched pharmacy records for purchases of glucose-lowering agents, including metformin, sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses were identified from the health maintenance organization cancer registry. We studied the association of cancer incidence with the use of specific glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin measurement. Cancer was diagnosed in 6% of the study cohort during 164,652 person-years of follow-up time. Cancer incidence increased with age and varied with medication purchasing patterns. On multivariate analysis, age (hazard ratio [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI, 1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were significantly associated with increased cancer risk, whereas number of metformin purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998). Male sex, age, and human insulin purchases were associated with increased cancer incidence, whereas metformin purchases were associated with decreased cancer risk. There was a trend for increased cancer incidence associated with use of long-acting insulin analogues, but the number of long-acting insulin analogue users was too small for risk estimates to be conclusive.
ER

PMID- 21696791
OWN - NLM
STAT- MEDLINE
DA  - 20110919
DCOM- 20111121
IS  - 1532-8600 (Electronic)
IS  - 0026-0495 (Linking)
VI  - 60
IP  - 10
DP  - 2011 Oct
TI  - Incidence of malignancies in patients with diabetes mellitus and correlation with
      treatment modalities in a large Israeli health maintenance organization: a
      historical cohort study.
PG  - 1379-85
LID - 10.1016/j.metabol.2011.05.002 [doi]
AB  - It has been hypothesized that incidence of and mortality from several
      malignancies are increased among diabetic patients. Whether certain treatment
      modalities, including use of metformin, sulfonylureas, or insulins, affect cancer
      incidence or mortality and whether use of long-acting insulin analogues glargine 
      and detemir may increase cancer incidence more than traditional human insulins
      are debated. The objective was to investigate the association between specific
      glucose-lowering agents and cancer incidence in diabetic members of an Israeli
      health maintenance organization. We studied a cohort of 36,342 diabetic patients 
      aged at least 18 years with no history of cancer or treatment with insulin as of 
      January 1, 2003. For the period from January 2003 to December 2007, we searched
      pharmacy records for purchases of glucose-lowering agents, including metformin,
      sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses
      were identified from the health maintenance organization cancer registry. We
      studied the association of cancer incidence with the use of specific
      glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin
      measurement. Cancer was diagnosed in 6% of the study cohort during 164,652
      person-years of follow-up time. Cancer incidence increased with age and varied
      with medication purchasing patterns. On multivariate analysis, age (hazard ratio 
      [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI,
      1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were
      significantly associated with increased cancer risk, whereas number of metformin 
      purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998).
      Male sex, age, and human insulin purchases were associated with increased cancer 
      incidence, whereas metformin purchases were associated with decreased cancer
      risk. There was a trend for increased cancer incidence associated with use of
      long-acting insulin analogues, but the number of long-acting insulin analogue
      users was too small for risk estimates to be conclusive.
CI  - Copyright (c) 2011 Elsevier Inc. All rights reserved.
FAU - Buchs, Andreas E
AU  - Buchs AE
AD  - Department of Medicine D, Assaf Harofe Medical Center, Zerifin, Israel.
      abuchs@asaf.health.gov.il
FAU - Silverman, Barbara G
AU  - Silverman BG
LA  - eng
PT  - Journal Article
DEP - 20110621
PL  - United States
TA  - Metabolism
JT  - Metabolism: clinical and experimental
JID - 0375267
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Algorithms
MH  - Cohort Studies
MH  - Diabetes Complications/*epidemiology/etiology
MH  - Diabetes Mellitus/*epidemiology/*therapy
MH  - Female
MH  - Health Maintenance Organizations/statistics & numerical data
MH  - Humans
MH  - Hypoglycemic Agents/*adverse effects/therapeutic use
MH  - Incidence
MH  - Israel/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Neoplasms/*epidemiology/*etiology
MH  - Sample Size
MH  - Young Adult
EDAT- 2011/06/24 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/06/24 06:00
PHST- 2011/01/20 [received]
PHST- 2011/05/02 [revised]
PHST- 2011/05/03 [accepted]
PHST- 2011/06/21 [aheadofprint]
AID - S0026-0495(11)00127-2 [pii]
AID - 10.1016/j.metabol.2011.05.002 [doi]
PST - ppublish
SO  - Metabolism. 2011 Oct;60(10):1379-85. doi: 10.1016/j.metabol.2011.05.002. Epub
      2011 Jun 21.
TY  - JOUR
AU  - Buchs, Andreas E.
AU  - Silverman, Barbara G.
PY  - 2011/Oct/21
TI  - Incidence of malignancies in patients with diabetes mellitus and correlation with treatment modalities in a large Israeli health maintenance organization: a historical cohort study.
T2  - Metab. Clin. Exp.
JO  - Metabolism: clinical and experimental
SP  - 1379
EP  - 1385
VL  - 60
IS  - 10
KW  - Adolescent
KW  - Adult
KW  - Aged
KW  - Aged, 80 and over
KW  - Algorithms
KW  - Cohort Studies
KW  - Diabetes Complications
KW  - Diabetes Mellitus
KW  - Female
KW  - Health Maintenance Organizations
KW  - Humans
KW  - Hypoglycemic Agents
KW  - Incidence
KW  - Israel
KW  - Male
KW  - Middle Aged
KW  - Neoplasms
KW  - Sample Size
KW  - Young Adult
N2  - It has been hypothesized that incidence of and mortality from several malignancies are increased among diabetic patients. Whether certain treatment modalities, including use of metformin, sulfonylureas, or insulins, affect cancer incidence or mortality and whether use of long-acting insulin analogues glargine and detemir may increase cancer incidence more than traditional human insulins are debated. The objective was to investigate the association between specific glucose-lowering agents and cancer incidence in diabetic members of an Israeli health maintenance organization. We studied a cohort of 36,342 diabetic patients aged at least 18 years with no history of cancer or treatment with insulin as of January 1, 2003. For the period from January 2003 to December 2007, we searched pharmacy records for purchases of glucose-lowering agents, including metformin, sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses were identified from the health maintenance organization cancer registry. We studied the association of cancer incidence with the use of specific glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin measurement. Cancer was diagnosed in 6% of the study cohort during 164,652 person-years of follow-up time. Cancer incidence increased with age and varied with medication purchasing patterns. On multivariate analysis, age (hazard ratio [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI, 1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were significantly associated with increased cancer risk, whereas number of metformin purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998). Male sex, age, and human insulin purchases were associated with increased cancer incidence, whereas metformin purchases were associated with decreased cancer risk. There was a trend for increased cancer incidence associated with use of long-acting insulin analogues, but the number of long-acting insulin analogue users was too small for risk estimates to be conclusive.
SN  - 1532-8600
UR  - http://dx.doi.org/10.1016/j.metabol.2011.05.002
UR  - http://www.ncbi.nlm.nih.gov/pubmed/21696791
ID  - Buchs2011
ER  - 
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