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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

New glargine cancer questions

The European Association for the Study of Diabetes (EASD) has recently held an annual conference in Vienna. At this event new data were presented that raise new questions about the association between cancer risk and the use of insulin analogues like glargine. This story has been reported in the medical media (Pulse).

The new data were collected from 300 GP practices in the UK. Analysis of the raw data found an association between a higher risk of cancer in those treated with insulin glargine alone compared to metformin alone. In addition, it was noted that combination treatment with insulin and metformin was associated with a reduced cancer risk the insulin alone.

After correction for age, gender and smoking status the differences remain with a 5.7-fold increased risk for insulin monotherapy and a 3.2-fold increase for the combination. In addition, there was a dose-dependent relationship which increases the possibility of causality.

It has been proposed that insulin therapy may be acting as a growth accelerator in patients who already have cancer. The manufacturer of insulin glargine (Lantus®) has announced (PDF) that it will conduct further research into the link. As noted in MeReC 41, insulin analogues are not recommended for routine use by the National Institute for Health and Clinical Excellence (NICE).

Action: Clinicians should be aware of the continued research into this association. It would be sensible to limit any new initiations of insulin analogue agents until more data are available.

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