The Incidence of Colorectal Cancer in Patients with Type 2 Diabetes Mellitus on Acarbose Therapy: A Nationwide Cohort Study in Taiwan

Han-Wen Liu ； Yu-Ann Fang ； Chun-Jen Chang ； Ting-I Lee

《Formosan Journal of Endocrinology and Metabolism》 7卷1期 (2016/06) Pp. 8-17

https://doi.org/10.6856/FJEM.201606_7(1).0002

摘要

Background. Acarbose, an alpha-glucosidase inhibitor, is an anti-diabetic drug used in clinical practice. It has been proposed that acarbose therapy may have beneficial and putative antineoplastic effect of the colon. We conducted a population-based cohort study to investigate long-term acarbose use and the incidence of colorectal cancer diagnosis in patients with type 2 diabetes. Methods. Using the National Health Insurance Research Database of Taiwan, a total of 21,337 patients with type 2 diabetes were included in the study and follow-up duration was 1 to 13 years. Results. The incidence rate of colorectal cancer was higher in the acarbose group than in the non-acarbose group (598.2 vs. 434.9 per 105 person-years). The adjusted hazard ratio (HR) was 1.97 (95% confidence interval [CI] 1.58 - 2.47). The adjusted HR was 1.09 (95% CI 0.87 - 1.37) for acarbose use within 1 - 7 years and 2.76 (95% CI 1.33 - 5.73) for duration more than 8 years. High proportion of our patients took metformin (92.87% of acarbose group, 91.02% of non-acarbose). Those who did not take metformin had similar incidence of colorectal cancer in both groups (acarbose vs. non-acarbose, 1,010.1 vs. 1,109.8 per 10^5 person-years), but those who took metformin had significant differences (acarbose vs. non-acarbose, 565.2 vs. 383.3 per 10^5 person-years; P ＜ 0.001). In our study cohort, metformin use was associated with lower incidence of colorectal cancer. Conclusion. Our finding suggests that the long-term use of acarbose might reduce the anti-colorectal cancer effect of metformin. However, further clinical study is warranted.

關鍵字

acarbose ； alpha-glucosidases ； colorectal cancer ； diabetes mellitus ； metformin