Wednesday, December 5, 2012

Fluke or Trend? Metformin vs Cancer Part 2

Yesterday, we took a look at a small case-control study demonstrating a link between metformin use and better survival in ovarian cancer.  In the final paragraph, I pointed another case-control study published in the British Medical Journal that served as the basis for this interest.  Just so we're clear, the study was published early online in April 2005 and in print in June 2005.  The authors compared 983 patients avg 73yo who'd been diagnosed to 1846 controls w/o cancer, all of whom were diabetic (avg duration 8.5yrs).  They then compared those who'd taken metformin to those who hadn't.  In the end, the authors concluded that the longer the duration on metformin and the greater the total dose of metformin, the lower the risk of developing diabetes.

Then in February 2010, a prospective cohort study was published in Diabetes Care in which 1,353 diabetics avg 68yo were followed for close to a decade on average.  Using statistics way above my pay grade, the authors concluded that all-cause mortality was more than twice that of non-diabetics.  This also applied to cardiovascular mortality while cancer mortality was just 45% greater.

Of note, the rate of cancer deaths was 62% greater in those diabetics who did not use metformin compared to non-diabetics but was actually 12% less (statistically non-significant) in those diabetics who took metformin compared to non-diabetics.  Did that make sense?  While diabetes increases one's risk of death from any cause, heart disease & cancer when compared to non-diabetes, use of metformin was associated w/lower risk of cancer deaths compared to not using the biguanide.  Looks like we have the start of a trend here!

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