Siddharth Singh 1 , Harkirat Singh , Preet Paul Singh , M Hassan Murad , Paul J Limburg Show Affiliations »
Abstract
BACKGROUND: Antidiabetic medications (ADM) may modify colorectal cancer risk in patients with diabetes mellitus. We performed a systematic review and meta-analysis, evaluating the effect of metformin, thiazolidinediones (TZD), sulfonylureas, and insulin on colorectal cancer risk in diabetic patients. METHODS: We conducted a systematic search of multiple bibliographic databases, up to September 2012, for articles that evaluated exposure to metformin, TZD, sulfonylureas, and insulin, reported colorectal cancer risk in patients with diabetes mellitus, and reported OR or provided data for their estimation. Summary OR estimates with 95% confidence intervals (CI) were estimated using the random-effects model. RESULTS: Fifteen studies reporting 13,871 cases of colorectal cancer in 840,787 patients with diabetes mellitus were included. Meta-analysis of observational studies showed an 11% reduction in colorectal cancer risk associated with metformin use (n = 9 studies; OR, 0.89; 95% CI, 0.81-0.99), whereas TZD use was not associated with colorectal cancer risk (n = 5 studies; OR, 0.96; 95% CI, 0.87-1.05). Conversely, a trend toward higher colorectal cancer risk was observed with sulfonylurea (n = 7 studies; OR, 1.11; 95% CI, 0.97-1.26) and insulin (n = 9 studies; OR, 1.33; 95% CI, 0.91-1.94) use, although these associations were not statistically significant. There was considerable heterogeneity across studies, partly explained by study location and adjustment for concomitant use of other ADMs. Post-hoc analysis of randomized controlled trials did not reveal any significant association between ADM and colorectal cancer risk. CONCLUSIONS: Meta-analysis of published studies supports a protective association between metformin use and colorectal cancer risk in patients with diabetes mellitus. IMPACT: Clinical trials on the chemopreventive effect of metformin against colorectal cancer are warranted. ©2013 AACR.
BACKGROUND: Antidiabetic medications (ADM) may modify colorectal cancer risk in patients with diabetes mellitus . We performed a systematic review and meta-analysis, evaluating the effect of metformin , thiazolidinediones (TZD ), sulfonylureas , and insulin on colorectal cancer risk in diabetic patients . METHODS: We conducted a systematic search of multiple bibliographic databases, up to September 2012, for articles that evaluated exposure to metformin , TZD , sulfonylureas , and insulin , reported colorectal cancer risk in patients with diabetes mellitus , and reported OR or provided data for their estimation. Summary OR estimates with 95% confidence intervals (CI) were estimated using the random-effects model. RESULTS: Fifteen studies reporting 13,871 cases of colorectal cancer in 840,787 patients with diabetes mellitus were included. Meta-analysis of observational studies showed an 11% reduction in colorectal cancer risk associated with metformin use (n = 9 studies; OR, 0.89; 95% CI, 0.81-0.99), whereas TZD use was not associated with colorectal cancer risk (n = 5 studies; OR, 0.96; 95% CI, 0.87-1.05). Conversely, a trend toward higher colorectal cancer risk was observed with sulfonylurea (n = 7 studies; OR, 1.11; 95% CI, 0.97-1.26) and insulin (n = 9 studies; OR, 1.33; 95% CI, 0.91-1.94) use, although these associations were not statistically significant. There was considerable heterogeneity across studies, partly explained by study location and adjustment for concomitant use of other ADMs. Post-hoc analysis of randomized controlled trials did not reveal any significant association between ADM and colorectal cancer risk. CONCLUSIONS: Meta-analysis of published studies supports a protective association between metformin use and colorectal cancer risk in patients with diabetes mellitus . IMPACT: Clinical trials on the chemopreventive effect of metformin against colorectal cancer are warranted. ©2013 AACR.
Entities: Chemical
Disease
Gene
Species
Mesh： See more »
Substances： See more »
Year: 2013
PMID： 24042261 DOI： 10.1158/1055-9965.EPI-13-0429
Source DB: PubMed Journal: Cancer Epidemiol Biomarkers Prev ISSN： 1055-9965 Impact factor: 4.254