Glycemic control and the incidence of neoplasm in patients with type 2 diabetes: a meta-analysis of randomized controlle
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META- ANALYSIS
Glycemic control and the incidence of neoplasm in patients with type 2 diabetes: a meta-analysis of randomized controlled trials Chu Lin
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Xiaoling Cai
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Wenjia Yang1 Fang Lv1 Lin Nie2 Linong Ji ●
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Received: 17 April 2020 / Accepted: 29 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Previous epidemiologic studies indicate an increased risk of cancer and cancer mortality in patients with type 2 diabetes (T2D). Whether the resolution of hyperglycemia will lead to reduced risk of neoplasm in T2D remains uncertain. Therefore, we performed a meta-analysis to assess the association between glycemic control and incidence of neoplasm in T2D patients. Methods Randomized controlled trials (RCTs) in T2D with significant HbA1c reduction difference between intensive/active and standard/control groups plus follow-up ≥48 weeks were included and analyzed by fixed-effect models, random-effect model, and meta-regression analysis accordingly. Results Overall, 52 studies were included. Compared with standard/control treatment, intensive/active treatment led to significantly greater HbA1c reduction from baseline (WMD = −0.51%, 95% CI, −0.55 to −0.46%, P < 0.001), but was not associated with a decreased incidence of neoplasm (OR = 0.99, 95% CI, 0.94–1.03, I2 = 2%) in T2D. Meta-regression analysis indicated that HbA1c reduction difference between intensive/active treatment and standard/control treatment was not associated with the incidence of neoplasm in T2D patients (β = −0.0011, 95% CI, −0.0058 to 0.0035, P = 0.625). In neoplasm-site subgroup analysis, a decreased incidence of breast neoplasm was observed in T2D patients using dipeptidylpeptidase-4 inhibitor (OR = 0.56, 95% CI, 0.35–0.89, I2 = 0%) and incidence of prostate neoplasm was reduced in T2D patients with glucagon-like peptide-1 receptor agonist treatment (OR = 0.66, 95% CI, 0.47–0.91, I2 = 0%). Conclusion Improved glycemic control in short and medium periods achieved by existing glucose-lowering drugs or strategies may not confer reduced risk of neoplasm in patients with T2D. Studies with longer follow-up duration are needed to better elucidate the long-period effects. Keywords Type 2 diabetes Glucose-lowering drugs Neoplasm Cancer ●
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Abbreviations BMI body mass index CI confidence interval CVOT cardiovascular outcome trial
Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02376-4) contains supplementary material, which is available to authorized users. * Xiaoling Cai [email protected] * Linong Ji [email protected] 1
Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
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Department of Endocrinology and Metabolism, Beijing Airport Hospital, Beijing, China
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DPP-4i ERK GLP-1RA MAPK OR PRISMA RCT ROT RR SGLT2i SU T2D TZD WMD
dipeptidyl-peptidase-4 inhibitor extracellular signal–regulated kinase glucagon-like peptide-1 analog mitogen-activated protein kinase od
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