Diabetes Treatment with Insulin Glargine and Risk of Malignancy

REVIEW ARTICLE

Dominique Simon^1,2,3 and Beverley Balkau^3,4

Affiliations: ¹Service de Diabetologie, Hopital de la Pitie, Paris, France; ²Universite Pierre et Marie Curie, Paris, France; ³Inserm, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of Diabetes, Obesity and Chronic Kidney Disease over the Lifecourse, Villejuif, France and ⁴University Paris Sud 11, UMRS-1018, Villejuif, France

ABSTRACT

An observational study in Germany implicated the specific action of insulin glargine to increase cancer risk; however, this study accumulated a number of methodological errors. There was no confirmation of these results in the three other European studies commissioned by the editor in chief of Diabetologia to validate or to refute the German data. Indeed, more generally, a moderate increase of cancer risk, with the exception of prostate cancer, has been shown in type 2 diabetic patients and in those with abnormal glucose tolerance, mainly digestive sites, independently of obesity. Insulin-resistance with compensatory hyperinsulinemia, and elevated levels of circulating growth factors are usually considered as the link between cancer and hyperglycemia, through activated cell proliferation. Treatments for diabetes that elevate plasma insulin seem to increase cancer risk and, in contrast, insulin-sensitizer drugs for diabetes (metformin, thiazolidinediones) seem to reduce cancer risk.

Keywords: type 2 diabetes, insulin glargine, cancer, hyperinsulinemia, growth factors, epidemiology, observational studies

Correspondence: Dominique Simon, Service de Diabétologie, 47 boulevard de l'Hôpital, 75013 Paris, France. Tel: +33 1 42 17 80 69; Fax: +33 1 42 17 82 39; e-mail: dominique.simon@psl.aphp.fr