Commentary: metformin use is associated with reduced gastric cancer risk – authors' reply
Abstract
We appreciate Dr de Vries and Kuipers for their interests and valuable comments1 in our recent article.2 In patients with type 2 diabetes, duration of diabetes, the use of anti-diabetic drugs including insulin, the severity of diabetes status and comorbidities associated with diabetes may play a role in increased risk of various cancers.3 In addition to those factors, Helicobacter pylori status, salt intake, several shared risk factors for both diabetes and gastric cancer such as obesity, insulin resistance, hyperinsulinaemia and smoking would be explanations on the putative mechanisms linking both diseases.4 In our study,2 those important factors that could affect the gastric cancer risk in type 2 diabetes were not included as covariates for the analyses due to the unavailability of the Korean National Health Insurance claim database. However, we divided the patients according to insulin use to reduce a bias associated with diabetes severity or the effect of exogenous insulin. We agree that further randomized controlled studies are needed to determine the effect of metformin use on the gastric cancer risk. The studies should include detailed information on duration of diabetes, diabetes severity, use of other anti-diabetics, dietary factors and especially H. pylori status. In addition, whether H. pylori eradication therapy plus treatment with metformin in diabetic patients is better than H. pylori eradication therapy alone in reducing gastric cancer risk would be an…
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Evidence Hub reads this as a randomized trial. 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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