上海交通大学医学院附属上海市第六人民医院贾伟平教授等开展的一项队列研究提示，接受人胰岛素治疗的2型糖尿病患者罹患癌症的整体风险虽未额外增加，但肝癌风险明显升高，其全因死亡和癌症死亡风险也增加。

研究者从上海糖尿病登记研究中纳入8774例从未接受胰岛素治疗的糖尿病患者，分入胰岛素治疗组和非胰岛素治疗组，接受随访至首次确诊癌症或死亡或至2011年7月31日。结果显示，胰岛素治疗组和非胰岛素治疗组分别确诊98例和170例癌症，发生率分别为78.6/万病人年和74.3/万病人年，两组的癌症发生风险无显著差异（经校正RR=1.20，P=0.228）。与非胰岛素治疗组相比，胰岛素治疗组的肝癌风险显著升高（经校正RR=2.84，P=0.028），全因死亡（经校正RR=1.89，P<0.0001）和癌症死亡（经校正RR=2.16，P=0.001）风险亦升高。

研究者表示，尽管胰岛素治疗组糖尿病患者的全因死亡和癌症死亡风险均较高，但其病情相对严重，故应谨慎解读该研究结果。

The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.

We recruited 8,774 insulin-naive diabetes patients from the Shanghai Diabetes Registry (SDR). The follow-up rate was 85.4%. All subjects were divided into the insulin use cohort (n =3,639) and the non-insulin use cohort (n = 5,135). The primary outcome was the first diagnosis of any cancer. The secondary outcome was all-cause mortality. Cox proportional hazards model was used to estimate the relative risk (RR) of cancer and mortality.

We observed 98 cancer events in the insulin use cohort and 170 in the non-insulin use cohort. Cancer incidence rates were 78.6 and 74.3 per 10,000 patients per year in the insulin users and the non-insulin users, respectively. No significant difference in cancer risk was observed between the two cohorts (adjusted RR=1.20, 95% CI 0.89-1.62, P=0.228). Regarding site-specific cancers, only the risk of liver cancer was significantly higher in the insulin users compared to that in the non-insulin users (adjusted RR = 2.84, 95% CI 1.12-7.17, P=0.028). The risks of overall mortality (adjusted RR = 1.89, 95% CI 1.47-2.43, P<0.0001) and death from cancer (adjusted RR = 2.16, 95% CI 1.39-3.35, P = 0.001) were all significantly higher in the insulin users than in the non-insulin users.

There was no excess risk of overall cancer in patients with type 2 diabetes who were treated with human insulin. However, a significantly higher risk of liver cancer was found in these patients. Moreover, insulin users showed higher risks of overall and cancer mortality. Considering that individuals treated with insulin were more likely to be advanced diabetic patients, caution should be used in interpreting these results.