Cheung, KS;
Chan, EW;
Wong, AYS;
Chen, L;
Seto, WK;
Wong, ICK;
Leung, WK;
(2019)
Metformin Use and Gastric Cancer Risk in Diabetic Patients After Helicobacter pylori Eradication.
Journal of the National Cancer Institute
, 111
(5)
pp. 484-489.
10.1093/jnci/djy144.
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Abstract
Background: Although prior studies showed metformin could reduce gastric cancer (GC) risk in patients with diabetes mellitus (DM), they failed to adjust for Helicobacter pylori infection and glycemic control. We aimed to investigate whether metformin reduced GC risk in H. pylori -eradicated diabetic patients and its association with glycemic control. Methods: This was a territory-wide cohort study using hospital registry database, recruiting all diabetic patients who were prescribed clarithromycin-based triple therapy for H. pylori infection from 2003 to 2012. Subjects were observed from H. pylori therapy prescription until GC diagnosis, death or end of study (December 2015). Exclusion criteria included GC diagnosed within first year of H. pylori therapy, prior history of GC or gastrectomy, and failure of H. pylori eradication. The hazard ratio (HR) of GC with metformin (defined as at least 180-day use) was estimated by Cox model with propensity score adjustment for covariates (age, sex, comorbidities, medications [including insulin], and time-weighted average hemoglobin A1c [HbA1c]). All statistical tests were two-sided. Results: During a median follow-up of 7.1 years (IQR:4.7–9.8), 37 (0.51%) of 7,266 diabetic patients developed GC at a median age of 76.4 years (IQR: 64.8–81.5 years). Metformin use was associated with a reduced GC risk (adjusted HR:0.49; 95% CI:0.24–0.98). There was a trend towards a lower GC risk with increasing duration (ptrend =0.01) and dose of metformin (ptrend=0.02) HbA1c level was not an independent risk factor for GC. Conclusions: Metformin use was associated with a lower GC risk among H. pylori -eradicated diabetic patients in a duration- and dose-response manner, which was independent of HbA1c level.
| Type: | Article |
|---|---|
| Title: | Metformin Use and Gastric Cancer Risk in Diabetic Patients After Helicobacter pylori Eradication |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/jnci/djy144 |
| Publisher version: | https://doi.org/10.1093/jnci/djy144 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | A1c level, A1c measurement, Non-insulin dependent diabetes mellitus, Insulin, Helicobacter pylori |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10055581 |
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