Cancer Risk of Insulin Key Focus at ADA
PHILADELPHIA -- Clinicians are hoping to get some answers about whether insulin analogs raise the risk of cancer from analyses of two large U.S. and northern European registries that will be presented at this year's American Diabetes Association meeting.
Both groups are comparing patients on insulin glargine (Lantus) with those on NPH, or "human," insulin to assess potential differences in incident cancer rates.
"This is an attempt to look at a large database and to get some sort of answer in terms of whether there's any increased risk of cancer," Sue Kirkman, MD, senior vice president for medical affairs and community information at the American Diabetes Association, told MedPage Today.
Concerns arose a few years ago when some studies published in Diabetalogia suggested an increased risk, particularly for breast cancer.
Researchers have since been trying to figure out whether that signal was real or not, Kirkman said. On one hand, insulin is a growth factor, which may increase cancer risk, but type 2 diabetes is in itself a risk factor for cancer.
"There's a lot of confounding including obesity, physical inactivity, and age, so it's hard to completely separate out the risk," she said.
In the case of insulin glargine in particular, it's a longer acting insulin and some studies have shown that it may react more strongly with the insulin-like growth factor (IGF) receptor than human insulins such as NPH, she said.
Subanalyses of the ORIGIN (Outcome Reduction with Initial Glargine Intervention) trial may also offer answers to the insulin-cancer connection, Kirkman said: "The trial didn't set out to look at cancer, but certainly with more recent interest in the topic of cancer and insulin, that's one of the safety issues they'll be looking at."
ORIGIN's main focus, however, is on preventing disease progression. Researchers will offer insights into whether treating prediabetes or early type 2 disease with insulin glargine has any impact on cardiovascular events or mortality, based on nearly eight years' worth of data from about 12,500 patients.
The trial also assessed whether giving omega-3 fatty acids early offers any benefits in this population, Kirkman said.
Treating Diabetes with Aspirin
Patients in the TINSAL-T2D (Targeting Inflammation using Salsalate for Type 2 Diabetes) study were randomized to salsalate or placebo and followed for a year to assess changes in HbA1c.
"It's interesting to see those results because the mechanism is quite different" from other diabetes drugs, Kirkman said. "I would doubt that it has such a huge effect that you could use it in people late instead of insulin, but I think it might be interesting as an early-on treatment" depending on the results of the trial.
Is Type 2 Diabetes Different in Kids?
Last month, results of the TODAY study dismayed clinicians when it found that large proportions of children with type 2 diabetes eventually stopped responding to their various therapies.
Just over half of kids on metformin (52%), 39% of those on metformin plus rosiglitazone (Avandia), and 47% of those on metformin plus lifestyle intervention eventually failed treatment during a 4-year period.
"It's a bit depressing in a way," Kirkman said. "It speaks to the need to be concerned about type 2 diabetes in adolescents. We should do what we can to prevent it instead."
Additional analyses of data from the TODAY study will be presented at a special session and may provide further clues to better management of the condition in this population.
Start Aggressive Management Early?
During a late-breaking session, researchers will provide additional analyses from the United Kingdom Prospective Diabetes Study (UKPDS), looking at the continued effects of early aggressive management.
Previous analyses have suggested that patients who had aggressive management early on in their disease had reduced rates of microvascular complications and cardiovascular disease and death. Further analyses will reveal whether that effect continues, Kirkman said.
"The theories are that perhaps ACCORD, ADVANCE, and VADT didn't show a major effect on complications because intensive glycemic control was started relatively late in the disease," she said. "It seems to matter when you start it."
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