Abstract:
OBJECTIVE:Observational studies have associated metformin use with a decreased risk of lung cancer incidence in patients with type 2 diabetes, but the studies had important methodological shortcomings. The objective of this study was to determine whether metformin use is associated with a decreased risk of lung cancer in patients with type 2 diabetes, while avoiding previous biases. RESEARCH DESIGN AND METHODS:Using the U.K. General Practice Research Database, we assembled a cohort of patients newly treated with oral hypoglycemic agents (OHAs) between 1988 and 2009. A nested case-control analysis was conducted, where case subjects with lung cancer occurring during follow-up were matched with up to 10 control subjects for age, sex, calendar time, and duration of follow-up. Conditional logistic regression was used to estimate adjusted rate ratios of lung cancer associated with ever use of metformin, along with measures of duration and cumulative dose. Models were adjusted for potential confounders, which included smoking. RESULTS:The cohort included 115,923 new users of OHAs, with 1,061 patients diagnosed with lung cancer during follow-up (rate 2.0/1,000 person-years). Metformin use was not associated with a decreased rate of lung cancer (rate ratio 0.94 [95% CI 0.76-1.17]). No dose-response was observed by number of prescriptions received, cumulative duration of use, and dose. CONCLUSIONS:Metformin use is not associated with a decreased risk of lung cancer in patients with type 2 diabetes. The decreased risk reported in other observational studies is likely due to bias from methodological shortcomings. Nonetheless, greater consideration should be given to clarify inconsistencies between experimental models and population studies.
journal_name
Diabetes Carejournal_title
Diabetes careauthors
Smiechowski BB,Azoulay L,Yin H,Pollak MN,Suissa Sdoi
10.2337/dc12-0740subject
Has Abstractpub_date
2013-01-01 00:00:00pages
124-9issue
1eissn
0149-5992issn
1935-5548pii
dc12-0740journal_volume
36pub_type
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