JAMA子刊:这类糖尿病患者癌症风险可升高5倍!都是胰岛素治疗惹的祸?

2022-08-03 MedSci原创 MedSci原创

JAMA Oncol:1型糖尿病患者每日胰岛素剂量与癌症风险

以前对1型糖尿病(T1D)患者的研究发现,与一般人群相比,该人群中某些癌症的发病率更高。然而,没有研究评估T1D癌症发病率的危险因素。在本研究中,研究人员使用糖尿病控制和并发症试验(DCCT)和糖尿病干预和并发症流行病学(EDIC)研究的数据,探索了28年随访期间T1D患者危险因素与癌症发病率的关联。

DCCT共纳入来自北美29家临床试验机构的1441例患者,数据搜集从1983年至1989年期间。到1993年DCCT结束,有1375例存活受试者继续参加EDIC研究。截至2012年,共有1304例患者具有每年癌症发病情况的完整更新数据。

研究者以每日平均胰岛素剂量水平将参与者分组:低剂量:<0.5单位/kg;中等剂量:0.5~0.8单位/kg;高剂量:≥0.8单位/kg。研究数据显示:在 33813人年的随访期间,在最终分析中的1303例患者中,有93例(7%)被确诊为癌症,癌症发病率为2.8(95%CI,2.2-3.3)/1000人年。患者初次癌症确诊的平均年龄为50岁,糖尿病平均病程为25年。

在确诊癌症的93例患者中,女性占57例(61%)。研究随访10年内确诊癌症的有8例(9%),11-20年期间确诊31例(33%),21-28年期间确诊54例(58%)。结果显示,1型糖尿病患者随着年龄增加,癌症发病率升高,年龄风险比(HR)为1.08(95%CI,1.05-1.12);女性发病率也升高,女性性别HR为1.74(95%CI,1.15-2.64)。


校正年龄和性别因素后分析数据表明:其他变量因素,包括运动习惯和HDL-C水平与癌症发病率呈负相关;每日胰岛素剂量与癌症发病风险呈正相关。此外,传统代谢因素,如肥胖、血糖控制水平、血压控制水平等与癌症发病风险之间并无关联。

值得关注的是,每日胰岛素剂量(尤其是高剂量)与癌症发生风险之间的关联比年龄和性别更为明显,每日胰岛素剂量与癌症发病风险升高显著相关(模型1:HR=5.93;95%CI,1.21-29.06;模型2:HR=4.13;95%CI,1.13-15.17)。

低、中、高剂量平均胰岛素组的癌症发病率分别为2.11/1000人年、2.87/1000人年、2.91/1000人年。高剂量组患者的癌症发病风险比低剂量组更高。

总的来说,本研究结果提示,每日胰岛素剂量与1型糖尿病患者的癌症发病风险相关,且高剂量组比低剂量组风险显著更高。本研究也是第一个探索1型糖尿病中癌症相关风险因素的研究。

 

原文来源:

Zhong W, Mao Y. Daily Insulin Dose and Cancer Risk Among Patients With Type 1 Diabetes. JAMA Oncol. Published online July 28, 2022. doi:10.1001/jamaoncol.2022.2960

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    2023-02-11 baoya
  2. [GetPortalCommentsPageByObjectIdResponse(id=1750334, encodeId=c5461e50334f0, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Sat Feb 11 08:10:40 CST 2023, time=2023-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1239277, encodeId=557012392e705, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ac94743156, createdName=840953868, createdTime=Wed Aug 17 13:57:30 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475322, encodeId=873a14e5322a8, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Thu Aug 04 01:10:40 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514677, encodeId=d44215146e773, content=<a href='/topic/show?id=c8d68389847' target=_blank style='color:#2F92EE;'>#胰岛素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83898, encryptionId=c8d68389847, topicName=胰岛素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e51610667367, createdName=zjshifan_98647309, createdTime=Thu Aug 04 01:10:40 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243626, encodeId=7699124362606, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Tue Aug 02 13:10:40 CST 2022, time=2022-08-02, status=1, ipAttribution=)]
    2022-08-17 840953868

    学习了

    0

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    2022-08-02 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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