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Caution Urged in Interpreting Glargine Cancer Risk


 

A series of studies reported last month by a European health organization has questioned whether the use of insulin glargine, known commercially as Lantus, inflates a patient’s risk of cancer. But according to one source, hospitalists with a large census of diabetic or hypoglycemic patients shouldn’t pull their patients off the treatment just yet.

Four different population-based studies were reported on the Web site for Diabetologia, the journal of the European Association of the Study of Diabetes. A German study of 127,000 patients in an insurance database found that for every 100 patients taking Lantus, there was one more person diagnosed with cancer when compared with 100 patients taking similar doses of human insulin. The risk increased with the dosage, the study reported.

But the American Diabetes Association quickly released a statement calling the studies “conflicting and confusing.”

Hospitalist Jeffrey Schnipper, MD, MPH, FHM, who estimates one-third of his patients are either diabetic or hypoglycemic, agrees, saying that observational studies make it hard to draw any conclusions.

“I tell patients we don’t know enough,” says Dr. Schnipper, director of clinical research and associate physician in the Division of General Medicine at Brigham and Women’s Hospital Hospitalist Service in Boston. “Right now, there’s no good strong evidence that Lantus is worse than any other alternative.”

Dr. Schnipper cautioned fellow hospitalists to not overreact to the reports, noting that without a randomized trial to follow through on the hypotheses raised, there is no resolution to the confounding-by-indication bias that can plague observational studies.

“There’s an adage in medicine that you never want to be the first person or the last person to use a drug,” Dr. Schnipper says. “I would say you should never be the first person or the last person to stop using a drug.”

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