Naslov
Insulin and cancer - what have we learn

Autori
Jandrić Balen, Marica

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, neobjavljeni rad, stručni

Skup
Adriatic Diabetes Forum

Mjesto i datum
Bled, Slovenija, 08.03.2013. - 10.03.2013

Vrsta sudjelovanja
Pozvano predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Cancer; insulin

Sažetak
Interrelationship between diabetes, its treatment and the various types of cancers has been a matter of extensive scientific debate debate for the past few years. Any association between cancer and diabetes melitus or cancer and insulin in general, if present, is complex, as it is difficult to separate disease-related effects from the role of various confounding variables typically associated with diabetes (e.g. obesity ; insulin resistance, less frequent preventive screening, etc). Insulin glargine is one of the most widely-studied insulins ; from preclinical trials throughout more than 100 clinical trials, with 10 years of real-life usage... Recent PK data form Bolli and his group in both T1 and T2 patients confirms that insulin glargine is extensively and quickly metabolized in the subcutaneous tissue and in the systemic circulation to its metabolites M1 and M2. The main circulating form of insulin glargine is M1 – it has been detected in plasma in a dose-related fashion correlating with the observed glucodynamic changes observed. Different study types provide us with different scientific evidence. According to this hierarchy metaanalisis of RCTs give us the highest level of such evidence. Such combined randomised control trial (n=31 RCTs) experience of malignancies in studies using insulin glargine was evaluated by Home with the conclusion that insulin glargine could not be associated with an increased incidence of cancr, including breast cancer, compared with the comparator. ORIGIN Trial is now the longest prospective study in a large number of individuals (n=12.537) receiving insulin glargine. Although the primary aim to test if provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, the results of the trial is the best scientific data we have so far to answer the question regarding a potential link between insulin and cancer. And the comforting result in the words of the ORIGIN researchers follows: ‘‘There was not an increase in incident cancers ; thus, these data do not support insulin in general or insulin glargine in particular to incident cancers during several years of exposure.’’ A broad Epidemiology Study Plan designed according to consented scientific standards and conducted by independent external has been sponsored by Sanofi. As part of this effort three studies have been initiated. Two of these are assessing the safety of insulin use by a retrospective analysis of well selected databases, while the third is a case control study. Results of those studies on more than 500.000 insulin users has been disclosed publicly during major scientific congresses in 2012. Shows that there is no increased risk for cancer in association with the use of insulin glargine compared to use of other insulins. On the basis of the findings from epidemiological studies, landmark ORIGIN trial and the latest welcome and overdue pharmacokinetic data —the chapter on whether insulin glargine per se is an independent risk factor for cancer should now be closed.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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