Insulin glargine and cancer--an unsubstantiated allegation.

1 Barbara Davis Center for Childhood Diabetes , Aurora, Colorado.
Diabetes Technology &amp Therapeutics (Impact Factor: 2.29). 08/2009; 11(8):473-6. DOI: 10.1089/dia.2009.1705
Source: PubMed
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    ABSTRACT: Advances in insulin therapy have made a positive contribution to improving disease management in both Type 1 and Type 2 diabetes. The development of insulin analogs with time–action characteristics has made it easier to mimic physiological insulin secretion. The parallel improvement in delivery devices has also made insulin therapy more convenient, flexible and acceptable. The inevitable progression of Type 2 diabetes means that the majority of those people will also require insulin therapy at some point in their disease course. Current treatment options are many; when to initiate insulin and which regimen to choose are among the major questions confronting physicians in today’s rapidly evolving environment. This article summarizes the current strategies for initiating and optimizing the use of the basal insulin analog, insulin glargine, in Type 2 diabetes, leading to the intermediate stage of insulin therapy with the introduction of meal-related, rapid-acting insulin analogs in a stepwise manner prior to a full replacement basal-bolus regimen.
    Expert Review of Endocrinology &amp Metabolism 01/2014; 7(4). DOI:10.1586/eem.12.29
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    ABSTRACT: An observational study in Germany implicated the specific action of insulin glargine to increase cancer risk; however, this study accumulated a number of methodological errors. There was no confirmation of these results in the three other European studies commissioned by the editor in chief of Diabetologia to validate or to refute the German data. Indeed, more generally, a moderate increase of cancer risk, with the exception of prostate cancer, has been shown in type 2 diabetic patients and in those with abnormal glucose tolerance, mainly digestive sites, independently of obesity. Insulin-resistance with compensatory hyperinsulinemia, and elevated levels of circulating growth factors are usually considered as the link between cancer and hyperglycemia, through activated cell proliferation. Treatments for diabetes that elevate plasma insulin seem to increase cancer risk and, in contrast, insulin-sensitizer drugs for diabetes (metformin, thiazolidinediones) seem to reduce cancer risk.
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    ABSTRACT: Cancer is the second cause of death. Association of diabetes as a growing and costly disease with cancer is a major health concern. Meanwhile, preexisting diabetes is associated with an increased risk of all-cause and cancer-specific mortalities. Presence of diabetes related comorbidities, poorer response to cancer treatment, and excess mortality related to diabetes are among the most important explanations. Although diabetes appear to be a risk factor for cancer and is associated with the mortality risk in cancer patients, several factors such as diabetes duration, multiple drug therapy, and the presence of diabetes comorbidities make the assessment of the effect of diabetes treatment on cancer risk and mortality difficult. Metformin is the drug of choice for the treatment of type 2 diabetes. The available evidence from basic science, clinical, and population-based research supports the anticancer effect of metformin. However, randomized controlled clinical trials do not provide enough evidence for a strong protective effect of metformin on cancer incidence or mortality. One of the most important limitations of these trials is the short duration of the followup. Further long-term randomized controlled clinical trials specifically designed to determine metformin effect on cancer risk are needed to provide the best answer to this challenge.
    01/2013; 2013:636927. DOI:10.1155/2013/636927


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