Commentary: metformin use is associated with reduced gastric cancer risk
Abstract
Type 2 diabetes mellitus has been associated with increased all cancer incidence, including gastric cancer. Both hyperinsulinaemia and inflammatory changes secondary to adiposity have been suggested as important underlying mechanisms.1, 2 The debate of possible advantage or disadvantage of metformin, and other blood glucose lowering drugs, with regard to cancer risk is of great importance given the widespread use of these drugs. Recently, use of incretins was reported to cause no increased risk of pancreatic cancer.3 Metformin is generally considered the first-line drug for treating type 2 diabetes, and is one of the most commonly prescribed drugs worldwide. Previous population-based reports have suggested a preventive effect of metformin for liver, colorectal, pancreas, oesophageal and stomach cancers, although the available evidence is inconclusive.4, 5 The anti-carcinogenic effects of metformin have been attributed to several mechanisms, including activation of LKB1/AMPK pathway, induction of cell cycle arrest and/or apoptosis, and activation of the immune system. Kim et al.6 report data from a Korean nationwide retrospective cohort study of type 2 diabetic patients. This interesting article, which is a valuable addition to the existing literature, reports a reduction in gastric cancer incidence among patients using metformin during more than 3 years, as compared to type 2 diabetic patients on other oral blood glucose lowering drugs. The relative risk of gastric cancer…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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