評估第2型糖尿病病患使用降血糖藥物與癌症風險之相關性研究

Evaluation of Association between Antidiabetic Therapy and Cancer Risks in Type 2 Diabetes

劉易宣(I-Hsuan Liu)

指導教授 ： 黃耀斌

共同指導教授 ： 辛錫璋(Shyi-Jang Shin)

高雄醫學大學/藥學院/臨床藥學研究所/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00166

摘要

研究背景：糖尿病和癌症均名列為國人前十大死因，皆屬國人之重要健康議題，近年來有越來越多研究顯示，第2型糖尿病病患有較高的癌症風險（包括罹病率和相關死亡率），而降血糖藥物為第2型糖尿病之主要治療方式，過去也有文獻指出降血糖藥物與癌症間的相關性，故本研究目的為利用台灣健康保險資料庫以第2型糖尿病病患為研究族群探討降血糖藥物與癌症間的相關性。

研究方法：本研究採重疊病例對照研究 (Nested case-control study)，使用資料為國衛院健康保險資料庫2005年百萬人承保抽樣歸人檔，篩選1997-1999年30歲以上第2型糖尿病病患為研究族群，病例組為研究族群於研究期間內（1997-2007）首次出現癌症診斷記錄者，對照組則由配對病例組而得，回溯兩組個案於指標日前之過去用藥記錄，再進行兩組間不同降血糖藥物之分析。

研究結果：研究族群共16,450人，總追蹤年數為160,808人年，病例組有2,687人，非病例組經1：2配對年齡、性別、指標年份、追蹤年數（±1年）等可能影響癌症風險之因子後得對照組5,369人。經過調整共病症和其他並用之降血糖藥物後，暴露於兩類降血糖藥物的病患有顯著性較高的癌症風險（調整後勝算比為1.16，95%信賴區間為1.03到1.31）；且其中以合併暴露於Metformin和Sulfonylureas雙藥物治療有顯著性較高的癌症風險（調整後勝算比為1.13，95%信賴區間為1.02到1.25）；另外，有暴露於Sulfonylureas，雖然未達顯著，但有較高之癌症風險趨勢（調整後勝算比為1.11，95%信賴區間為1.00到1.25）；而Sulfonylureas 中以Glyburide（Glibenclamide）有顯著性較高的癌症風險（調整後勝算比為1.15，95%信賴區間為1.01到1.31）。其他降血糖藥物治療包括：Meglitinides、Insulin、Thiazolidinediones（TZD）和Acarbose與癌症風險則未有顯著相關性。

結論：降血糖藥物中，Sulfonylureas有較高癌症風險的趨勢，其中又以Glyburide（Glibenclamide）有顯著性較高之癌症風險，而合併Sulfonylureas和Metformin也有顯著性較高之癌症風險，其他降血糖藥物則未發現與癌症風險有顯著相關性。

關鍵字

第2型糖尿病 ； 降血糖藥物 ； 癌症

並列摘要

Background: Several studies have suggested an association between specific antidiabetic medications and cancer morbidity. This study was aimed at the assessment of association between different antidiabetic medications and cancer risks by using Taiwan National Health Insurance claims database.

Methods: We used the Longitudinal Health Insurance Database 2005 (LHID 2005) (1997-2007) to conduct a nested matched case-control study. Among the study population of type 2 diabetic patients, we identified 2,687 ptaients who had an incident malignancy. 5,369 controls were matched with the corresponding cases for age, sex, duration of follow-up and index year. Multiple logistic regression was used and ORs were estimated for assessing association between antidiabetic medications and cancer risks.

Results: Dual therapy of metformin and Sulfonylureas was significant associated with higher cancer risks (adjusted OR 1.13, 95%CI 1.02-1.25). Among Sulfonylureas, glyburide (glibenclamide) treatment was associated with a significant higher cancer risks (adjusted OR 1.15, 95%CI 1.01-1.31). There was no significant association between treatment with meglitinides, insulin, thiazolidinediones, or acarbose and cancer risk. And long-term treatments also showed no significant association with cancer risk.

Conclusion: The results of this study show that only Sulfonylureas has a trend to increase cancer risks whereas other antidiabetic medications do not. Dual therapy with metformin and Sulfonylureas shows significant higher cancer risk. And the duration of antidiabetic medication exposure didn’t show well association with cancer risks. Further studies are needed to confirm the results.

並列關鍵字

Type 2 diabetes ； Antidiabetic therapy ； Cancer

參考文獻

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