Table 1: Cancer risk with oral agents and insulin therapy.
(a) Population studies of oral antidiabetic medications and cancer risk

StudyPublish year country
(study Yrs)
Increased risk (OR with 95% CI)Cancer type(s)

Evans et al. [79] case-control hospitalized patients2005 Scotland
(1993–2001)
No
(i) Metformin (OR 0.77)
None specified (All incidence of cancers)

Bowker et al. [80] retrospective2006 Canada
(1991–1996)
Yes
(i) SFU compared to metformin (HR 1.3, )
(ii) Insulin (HR 1.9, )
None specified (Looked specifically at cancer-related mortality and not cancer type.)

Monami et al. [81] case control2009 Italy
(1998–2004)
After >36 months of use:
No
(i) Acarbose (OR 0.77)
(ii) Glicazide (OR 0.40)
(iii) Glitazones (OR 1.05)
(iv) Insulin (OR 0.91)
(v) Metformin (OR 0.28)
(vi) Other SFU (OR 1.05)
(vii) Repaglinide (OR 0.87)
After >36 months of use:
Yes
(i) Glibenclamide (OR 2.62, )
GI breast
genital tract
(male/female)
pancreas
lung

Li et al. [64] case control hospitalized patients2009 United States
(2004–2008)
No
(i) Metformin (OR 0.38)
Yes
(i) Insulin (OR 4.99)
(ii) Insulin secretagogues (OR 2.52)
(iii) TZD’s (OR 1.55)
Pancreas (adenocarcinoma)

Mannucci et al. [82] case control2010 Italy
(1998–2007)
No
(i) Other insulin: lispro, aspart, and human insulin
(ii) Metformin
Yes
(i) ≥0.3 IU/kg/d of glargine
GI
hepatic
pancreatic
lung
leukemia/lymphoma
breast
urogenital
prostate
20 “other cancers”

(b) Meta-analyses of insulin and cancer

StudyPublish Year country (study Yrs)Total number of studiesTotal ( )Insulin analyzedIncreased risk?

Dejgaard et al. [83] Meta-analysis of randomized controlled Novo Nordisk trials Type I and Type II2009 Denmark218693Detemir NPH glargineNo
(i) Glargine and detemir had similar risk
Yes
(i) NPH had more risk than detemir

Home et al. [84] Meta-analysis of randomized controlled Sanofi Aventis trials Type I and Type II2009 United Kingdom3110,880GlargineNo

(c) Population studies of insulin and cancer risk

StudyPublish year country
(study Yrs)
Total ( )Insulin analyzedIncreased risk?

Yang et al. [85] retrospective cohort2004 United Kingdom (1987–2002)24,918Insulin analogues (types not specified)Yes
colorectal cancer
Donadon et al. [86] case control2008 Italy (1994–2006)955Insulin analogues (types not specified)Yes
hepatocellular cancer in insulin-treated males

Hemkens et al. [87] retrospective cohort2009 German (1998–2005)127,031Aspart, glargine, human insulin, lisproYes
may be dose dependent

Jonasson et al. [88] retrospective cohort2009 Sweden (2005–2007)114,841GlargineNo

Colhoun et al. [89] retrospective cohort2009 Scotland (2002–2005)36,254GlargineNo

Currie et al. [90] retrospective cohort2009 United Kingdom
(2000–2005)
62,809Insulin analogues (types not specified) oral agentsNo

Rosenstock et al. [91] randomized control2009 United States (5 years)1017NPH, glargineNo

Yang et al. [22] retrospective cohort2010 Hong Kong (1996–2005)4623Insulin analogues (types not specified)No