Cancer risk among insulin users: comparing analogues with human insulin in the CARING five-country cohort study

Anna But*, Marie L. De Bruin*, Marloes T. Bazelier, Vidar Hjellvik, Morten Andersen, Anssi Auvinen, Jakob Starup-Linde, Marjanka K. Schmidt, Kari Furu, Frank de Vries, Oystein Karlstad, Nils Ekstrom, Jari Haukka

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Aims/hypothesis The aim of this work was to investigate the relationship between use of certain insulins and risk for cancer, when addressing the limitations and biases involved in previous studies.

Methods National Health Registries from Denmark (1996-2010), Finland (1996-2011), Norway (2005-2010) and Sweden (2007-2012) and the UK Clinical Practice Research Datalink database (1987-2013) were used to conduct a cohort study on new insulin users (N = 327,112). By using a common data model and semi-aggregate approach, we pooled individual-level records from five cohorts and applied Poisson regression models. For each of ten cancer sites studied, we estimated the rate ratios (RRs) by duration (6 years) of cumulative exposure to insulin glargine or insulin detemir relative to that of human insulin.

Results A total of 21,390 cancer cases occurred during a mean follow-up of 4.6 years. No trend with cumulative treatment time for insulin glargine relative to human insulin was observed in risk for any of the ten studied cancer types. Of the 136 associations tested in the main analysis, only a few increased and decreased risks were found: among women, a higher risk was observed for colorectal (RR 1.54, 95% CI 1.06, 2.25) and endometrial cancer (RR 1.78, 95% CI 1.07, 2.94) for 6 years (RR 0.22, 95% CI 0.05, 0.92). Comparisons of insulin detemir with human insulin also showed no consistent differences.

Conclusions/interpretation The present multi-country study found no evidence of consistent differences in risk for ten cancers for insulin glargine or insulin detemir use compared with human insulin, at follow-up exceeding 5 years.

Original languageEnglish
Pages (from-to)1691-1703
Number of pages13
JournalDiabetologia
Volume60
Issue number9
DOIs
Publication statusPublished - Sep 2017

Keywords

  • Cancer risk
  • Cohort study
  • Common datamodel
  • Cumulative treatment time
  • Detemir
  • Glargine
  • Human insulin
  • Insulinanalogues
  • Newinsulinuser
  • Poissonmodel
  • Rate ratio
  • Semi-aggregate
  • Site-specific
  • DIABETES-MELLITUS
  • COLORECTAL-CANCER
  • GLYCEMIC CONTROL
  • GLARGINE USE
  • NPH INSULIN
  • METAANALYSIS
  • ASSOCIATION
  • BIAS
  • MALIGNANCIES
  • MORTALITY

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