Téma: Clinical pharmacology

Insulin analogues and risk of tumors

Jozef Mardiak

Both type 1 and type 2 diabetes mellitus are independent predictors of several types of cancer. The promoting effect of insulin on the growth of cancer cells has been known for more than 30 years. Insulin analogues were developed by changing the molecular structure of humane insulin to adjust the effect of endogenous insulin. Mitogenic capacity of insulin is determined by the strength of binding to the IGF-1 receptor and by the duration of the bond. IGF-1 receptor stimulates cell growth and proliferation; it promotes cell survival and inhibits apoptosis. These are the mechanisms of IGF-1 that are considered to be the likely actors in cancer development. Recently the safety of treatment with insulin analogues has been under an intense scrutiny, mainly of insulin glargine, because of the epidemiological signal of increased incidence of certain types of cancer. However, the results require careful interpretation because of methodological limitations of the studies, including relatively short-term follow-up, suboptimal matching of evaluated groups, as well as limitations of information from the databases used for analyses. Analyses concerning insulin glargine do not raise any concerns for short-acting insulin analogues or premixed insulin analogues. In vitro documented characteristics of insulin detemir, form a solid base for its safe use in the clinical practice.

Ročník 2010  Témy časopisu Internal medicine 4 / 2010

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