Clinical-alimentary tractInsulin therapy and colorectal cancer risk among type 2 diabetes mellitus patients
Section snippets
Study design
We conducted a retrospective cohort study with a nested case-control analysis in the General Practice Research Database (GPRD). This study was approved by the University of Pennsylvania Institutional Review Board and the GPRD Scientific and Ethical Advising Group.
Source of data
The GPRD was established in 1987. It constitutes the primary outpatient medical record for approximately 700 general practitioner practices in the United Kingdom. Patients in the database are representative of the United Kingdom
Results
The insulin-exposed (i.e., at least 1 year of insulin exposure) group accumulated 9157 person-years of follow-up, and the unexposed group was followed for 85,556 person-years. The median duration of insulin therapy was 3 years (range, 1–13.5 years). The noninsulin users were older than the insulin users (71 years [SD, 12 years] vs. 68 years [SD, 12 years], P < 0.0001). The duration of type 2 diabetes mellitus was significantly longer in insulin users than noninsulin users (13 years [SD, 7
Discussion
This study provides direct epidemiologic support for the hypothesis that long-term insulin therapy is associated with an increased risk of colorectal cancer among type 2 diabetes mellitus patients. Because insulin use is inextricably linked to severity of type 2 diabetes mellitus, it is possible that the observed association is due to the severity of diabetes rather than a true effect of exogenous insulin. However, a causal interpretation is supported by prior experimental and clinical
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Supported by the National Institutes of Health center grant P30 DK50306.