糖尿病及長效胰島素類似物是否增加病人罹患腫瘤的風險？——1例糖尿病合并胰腺癌患者的循證治療_《中國循證醫學雜志》

作者：

孫倩倩 ,  王雙 , 鄭玉霞 , 廖再波

四川大學華西醫院老年病科（成都?610041）;

關鍵詞：

糖尿病長效胰島素類似物（甘精胰島素）腫瘤血糖控制循證實踐

DOI：

10.7507/1672-2531.20110059

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目的　糖尿病與腫瘤的關系以及長效胰島素類似物是否致癌是目前頗有爭議的熱點問題，結合1例糖尿病合并胰腺癌患者的病情，用循證臨床實踐的方法，對糖尿病與腫瘤的關系及長效胰島素類似物是否致癌進行討論。
方法　計算機檢索Cochrane圖書館（2010年第3期）、OVID-EBM Reviews（1991～2010.9）、MEDLINE（1950～2010.9）、CNKI（2000～2010.9），查找高質量臨床證據，并根據患者意愿為患者制定最佳治療方案。
結果　共納入8個RCT，4個Meta分析，1個RCT聯合分析。證據表明：① 糖尿病與惡性腫瘤的發病有一定關系；② 目前尚無證據表明長效胰島素類似物與腫瘤發生間存在關聯；③ 糖尿病患者嚴格控制血糖不增加罹患腫瘤的風險，但高血糖也無導致腫瘤的證據；④ 合并腫瘤的糖尿病患者是否停用長效胰島素類似物，需征求專科醫師意見，患者不宜自行調整。該患者糖尿病治療措施不變。
結論　目前尚無高質量證據表明糖尿病、使用長效胰島素類似物（甘精胰島素）、糖尿病患者嚴格控制血糖與腫瘤的發生有關系。正在接受甘精胰島素治療的合并腫瘤的糖尿病患者是否需要調整治療方案尚需更多證據。

引用本文： 孫倩倩,王雙,鄭玉霞,廖再波. 糖尿病及長效胰島素類似物是否增加病人罹患腫瘤的風險？——1例糖尿病合并胰腺癌患者的循證治療. 中國循證醫學雜志, 2011, 11(3): 346-349. doi: 10.7507/1672-2531.20110059 復制

1.	1 Hemkens LG, Grouven U, Bender R, et al . Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort study. Diabetologia , 2009, 52(9): 1732-1744.
2.	Jonasson JM, Ljung R, Talback M, et al . Insulin glargine use and short-term incidence of malignancies—a population-based follow-up study in Sweden. Diabetologia , 2009, 52(9): 1745-1754.
3.	Kuriki K, Hirose K, Tajima K, et al . Diabetes and cancer risk for all and specific sites among Japanese men and women. Cancer Pre , 2007, 16(1): 83-89.
4.	Huxley R, Ansary-Moghaddam A, Berrington de gonzalez A, et al . Type-Ⅱdiabetes and pancreatic cancer: a meta-analysis of 36 studies. Brit J of Cancer , 2005, 92(11): 2076-2083.
5.	Larsson SC, Orsini N, Wolk A. Diabetes Mellitus and Risk of Colorectal Cancer: A Meta-Analysis. Nati Cancer Inst , 2005, 97(22): 1679-1687.
6.	Hemminki K, Li XJ, Sundquist J, et al . Risk of Cancer Following Hospitalization for Type 2 Diabetes. Oncologist , 2010, 15(6): 548-555.
7.	Colhoun HM, SDRN Epidemiology Group. Use of insulin glargine and cancer incidence in Scotland: A study from the Scottish Diabetes Research Network Epidemiology Group. Diabetologia ,.
8.	Currie CJ, Poole CD, Gale EA. The influnece of glucose-lowering therapies on cancer risk in type 2 diabetes. Diabetologia , 2009, 52(9): 1766-1777.
9.	Rosenstock J, Fonseca V, McGill JB, et al . Similar risk of malignancy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: findings from a 5 year randomized, open-label study. Diabetologia , 2009, 52(9): 1971-1973.
10.	Dejgaard A, Lynggaard H, Rastam J, et al . No evidence of increased risk of malignancies in patients with diabetes treated with insulin detemir: a meta-analysis. Diabetologia , 2009, 52(12): 2507-2512.
11.	Home PD, Lagarenne P. Combined randomised control trial experience of malignancies in studies using insulin glargine. Diabetologia , 2009, 52(12): 2499-2506.
12.	ORIGIN Trial Investigators, Gerstein H, Yusuf S, et al . Rationale design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). Am Heart J , 2008, 155(1): 26-32.
13.	Johnson JA, Bowker SL. Intensive glycaemic control and cancer risk in type 2 diabetes: a meta-analysis of major trials. Diabetologia , 2011, 54(1): 25-31.
14.	, 52(9): 1755-1765.

1. 1 Hemkens LG, Grouven U, Bender R, et al . Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort study. Diabetologia , 2009, 52(9): 1732-1744.
2. Jonasson JM, Ljung R, Talback M, et al . Insulin glargine use and short-term incidence of malignancies—a population-based follow-up study in Sweden. Diabetologia , 2009, 52(9): 1745-1754.
3. Kuriki K, Hirose K, Tajima K, et al . Diabetes and cancer risk for all and specific sites among Japanese men and women. Cancer Pre , 2007, 16(1): 83-89.
4. Huxley R, Ansary-Moghaddam A, Berrington de gonzalez A, et al . Type-Ⅱdiabetes and pancreatic cancer: a meta-analysis of 36 studies. Brit J of Cancer , 2005, 92(11): 2076-2083.
5. Larsson SC, Orsini N, Wolk A. Diabetes Mellitus and Risk of Colorectal Cancer: A Meta-Analysis. Nati Cancer Inst , 2005, 97(22): 1679-1687.
6. Hemminki K, Li XJ, Sundquist J, et al . Risk of Cancer Following Hospitalization for Type 2 Diabetes. Oncologist , 2010, 15(6): 548-555.
7. Colhoun HM, SDRN Epidemiology Group. Use of insulin glargine and cancer incidence in Scotland: A study from the Scottish Diabetes Research Network Epidemiology Group. Diabetologia ,.
8. Currie CJ, Poole CD, Gale EA. The influnece of glucose-lowering therapies on cancer risk in type 2 diabetes. Diabetologia , 2009, 52(9): 1766-1777.
9. Rosenstock J, Fonseca V, McGill JB, et al . Similar risk of malignancy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: findings from a 5 year randomized, open-label study. Diabetologia , 2009, 52(9): 1971-1973.
10. Dejgaard A, Lynggaard H, Rastam J, et al . No evidence of increased risk of malignancies in patients with diabetes treated with insulin detemir: a meta-analysis. Diabetologia , 2009, 52(12): 2507-2512.
11. Home PD, Lagarenne P. Combined randomised control trial experience of malignancies in studies using insulin glargine. Diabetologia , 2009, 52(12): 2499-2506.
12. ORIGIN Trial Investigators, Gerstein H, Yusuf S, et al . Rationale design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). Am Heart J , 2008, 155(1): 26-32.
13. Johnson JA, Bowker SL. Intensive glycaemic control and cancer risk in type 2 diabetes: a meta-analysis of major trials. Diabetologia , 2011, 54(1): 25-31.
14. , 52(9): 1755-1765.

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糖尿病及長效胰島素類似物是否增加病人罹患腫瘤的風險？——1例糖尿病合并胰腺癌患者的循證治療

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《中國循證醫學雜志》

糖尿病及長效胰島素類似物是否增加病人罹患腫瘤的風險？——1例糖尿病合并胰腺癌患者的循證治療

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