Increased cancer incidence risk in type 2 diabetes mellitus: results from a cohort study in Tyrol/Austria.

BACKGROUND: Recent meta-analyses revealed an association between type 2 diabetes mellitus (T2DM) and cancer. The strongest relationship was demonstrated for liver and pancreatic cancer, followed by endometrial cancer. We aimed at assessing the association between T2DM and cancer specifically for Tyrolean patients. METHODS: We investigated cancer incidence in Tyrolean subjects with T2DM by linking the data from the Diabetes and the Cancer Registries. 5709 T2DM patients were included and the sex- and age-adjusted standardized incidence ratio (SIR) was calculated, cancer incidence in the Tyrolean population serving as the standard. Endpoints were the time at which cancer was diagnosed, death or end of the observation period (31 December 2010). RESULTS: Site-specific analyses revealed statistically significantly elevated SIRs for cancer of the pancreas (1.78, 95% CI 1.02, 2.89) and corpus (1.79, 95% CI 1.15, 2.66) for women, and cancer of the liver (2.71, 95% CI 1.65, 4.18) and pancreas (1.87, 95% 1.11, 2.96) for men. Sub-analyses performed according to the time of diabetes diagnosis revealed that SIR was highest in the first year after diabetes diagnosis, but SIR was demonstrated to be elevated in women for cancer of the liver (SIR 3.37, 95% CI 1.24, 7.34) and corpus (SIR 1.94, 95% CI 1.09, 3.20) and in men for liver (SIR 2.71, 95% CI 1.40, 4.74) in the period more than five years after diabetes diagnosis. In addition, increased risk at borderline statistical significance was observed in females for liver cancer (SIR 2.40, 95% CI 0.96, 4.94) and cervical cancer (SIR 1.81, 95% CI 0.87, 3.32) and in males for kidney cancer (SIR 1.65, 95% CI 0.99, 2.57). CONCLUSION: This study revealed a higher risk for cancer at certain sites in Tyrolean patients with T2DM. However, it is important to interpret the results with great caution due to inherent methodological problems. Optimized care programs for patients with T2DM should be integrated into the recommended procedures for cancer screening.

Long-term trends in the prescription of antidiabetic drugs: real-world evidence from the Diabetes Registry Tyrol 2012-2018.

INTRODUCTION: Prescription patterns of antidiabetic drugs in the period from 2012 to 2018 were investigated based on the Diabetes Registry Tyrol. To validate the findings, we compared the numbers with trends of different national registries conducted in a comparable period of time. RESEARCH DESIGN AND METHODS: Medication data, prescription patterns, age groups, antidiabetic therapies and quality parameters (hemoglobin A1c, body mass index, complications) of 10 875 patients with type 2 diabetes from 2012 to 2018 were retrospectively assessed and descriptively analyzed. The changes were assessed using a time series analysis with linear regression and prescription trends were plotted over time. RESULTS: Sodium/glucose cotransporter 2 inhibitors (SGLT-2i) showed a significant increase in prescription from 2012 to 2018 (p<0.001), as well as metformin (p=0.002), gliptins (p=0.013) and glucagon-like peptide-1 agonists (GLP-1a) (p=0.017). Significant reduction in sulfonylurea prescriptions (p<0.001) was observed. Metformin was the most frequently prescribed antidiabetic drug (51.3%), followed by insulin/analogs (34.6%), gliptins (28.2%), SGLT-2i (11.7%), sulfonylurea (9.1%), glitazones (3.7%), GLP-1a (2.8%) and glucosidase inhibitors (0.4%). CONCLUSIONS: In this long-term, real-world study on prescription changes in the Diabetes Registry Tyrol, we observed significant increase in SGLT-2i, metformin, gliptins and GLP-1a prescriptions. In contrast prescriptions for sulfonylureas declined significantly. Changes were consistent over the years 2012-2018. Changes in prescription patterns occurred even before the publication of international and national guidelines. Thus, physicians change their prescription practice not only based on published guidelines, but even earlier on publication of cardiovascular outcome trials.

Prescription of oral antidiabetic drugs in Tyrol - Data from the Tyrol diabetes registry 2012-2015.

Diabetes mellitus affects 9% of the adult population worldwide and the economic burden of the disease is growing exponentially. In type 2 diabetes mellitus (T2DM), when life style interventions fail to achieve treatment targets, oral antidiabetic drugs are prescribed to improve glycemic control. Several new oral antidiabetics have been launched in the last few years, which enlarged the spectrum of available treatment options in T2DM. The present study aimed to examine T2DM treatment patterns in a cohort of 7769 patients recruited from the Diabetes Registry Tyrol (DRT) with at least one visit from 2012-2015. Secondly, the study aimed to evaluate the use of new oral antidiabetics compared to older oral antidiabetics (OAD). It was found that 43.4% of all patients were treated with OAD alone while 21.2% had oral antidiabetics combined with insulin. 19.9% of the study population were treated with insulin or insulin analogs only. 15.3% had no pharmacological treatment. Metformin was used most frequently (47.9% of the study population), followed by gliptines (27.2%). The most common treatment regimen in this population was the dual therapy of metformin and another OAD (17.2%), followed by metformin monotherapy (16.6%) and triple therapy of metformin and two additional OAD (11.0%).

Multicentre evaluation of a new point-of-care test for the determination of CK-MB in whole blood.

BACKGROUND: The point-of-care (POC) test Roche CARDIAC CK-MB is a new assay which has been developed for the existing Roche Cardiac reader system. METHODS: We performed a multicentre evaluation at six sites to assess the analytical performance of the POC CK-MB assay and to compare it with a quantitative laboratory CK-MB assay. RESULTS: Within-series coefficients of variation (CV) resulting from 34 ten-fold measurements with patient samples ranged from 4.3% to 16.4%. Using quality control material, the mean CV values for day-to-day imprecision were 6.5% for the low level control and 8.4% for the high level control. Based upon 847 pairs of values, the mean relative bias of three independently calibrated lots of the POC CK-MB assay ranged from -6% to -11% in method comparisons with the lab CK-MB assay. The mean relative lot-to-lot differences of POC CK-MB were between -2% and +1%. No interference was observed with lipaemic blood (triglyceride concentrations up to 8.1 mmol/L), icteric blood (bilirubin concentrations up to 513 micromol/L), haemolytic blood (haemoglobin concentrations up to 0.12 mmol/L), biotin (up to 30 mg/L) and rheumatoid factor (up to 119 IU/mL), or with 53 standard or cardiological drugs even in toxic concentrations. There was no influence on the results by varying haematocrit values in the range from 21% to 54%. A slight interference with human anti-mouse antibodies type 2 was found. No significant influence on the results with POC CK-MB was found by using sample volumes between 135 and 165 microL. High CK-MB concentrations above the measuring range of POC CK-MB (1-40 microg/L) did not lead to false low results due to potential high-dose hook effect. No significant effect of sample age on recovery occurred up to a sample age of 24 h. No cross-reactivity was found between the POC CK-MB assay and either CK-MM or CK-BB. A substudy with healthy individuals confirmed the reference limits of 3.8 microg/L for females and 6.7 microg/L for males. CONCLUSIONS: The POC CK-MB assay showed a very good analytical performance with an excellent concordance with the calibration and reference laboratory method. It should be therefore suitable for its intended use in POC settings. Clin Chem Lab Med 2008;46:630-8.