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2012 ADA Posters 1181-2156.Indd EPIDEMIOLOGYCATEGORY EPIDEMIOLOGY & 1331-P Time Since Diagnosis and Insulin Use In Relation to Cancer Preva- Guided Audio Tour: Epidemiology of Diabetes Treatment (Posters 1329-P lence Among U.S. Adults With Diagnosed Diabetes: Findings from to 1334-P), see page 15. the 2009 Behavioral Risk Factor Surveillance System CHAOYANG LI, GUIXIANG ZHAO, CATHERINE A. OKORO, JOHN WEN, EARL S. FORD, LINA S. BALLUZ, Atlanta, GA & 1329-P Growing evidence from epidemiological studies has suggested that dia- Treatment of People With Type I Diabetes in the US: The Impact betes is associated with an increased risk or prevalence for certain types Database of cancer. Little is known about the correlates of cancer prevalence among PETER CHASE, JAY LIN, EDWARD WANG, SATISH GARG, Aurora, CO, Flemington, people with diabetes. This study examined the association of time since NJ, Bridgewater, NJ diagnosis and use of insulin with self-reported cancer among U.S. adults The treatment pattern of people in the US with type 1 diabetes (T1D) with diagnosed diabetes. We analyzed data for 25,964 adults with diag- was analyzed using the Ingenix Impact National Managed Care Database nosed diabetes who participated in the 2009 Behavioral Risk Factor Sur- that includes medical and pharmacy history of > 60 million US people.From veillance System. After adjustment for potential confounders, there was an 1/1/2007 to 6/30/2009, people with diabetes were identifi ed who had con- increasing trend in the adjusted prevalence ratios of time since diagnosis tinuous medical and prescription insurance coverage during the 12 months for cancers of all sites among men (time since diagnosis 0-4 years: referent; before (baseline) and 12 months after (follow-up) the fi rst date of diagnosis 5-9 years: adjusted prevalence ratio [APR], 2.4, 95% confi dence interval [CI], recorded in the study period. People with T1D were identifi ed by a diagnosis 1.8-3.3; 10-14 years: 2.5, 1.9-3.3; *15 years: 3.1, 2.3-4.2) (P <0.0001 for linear of diabetic ketoacidosis (ICD-9 code 250.1x) or having * 1 inpatient primary trend) and women (0-4 years: referent; 5-9 years: 1.8, 1.3-2.4; 10-14 years: or secondary diagnoses or * 2 outpatient primary or secondary diagnoses of 2.1, 1.5-2.9; *15 years: 2.7, 2.0-3.5) (P <0.0001 for linear trend). In type 2 T1D (ICD-9 code 250.x1 or 250.x3) without any T2D diagnoses. Only people diabetes, the prevalence estimate for cancers of all sites was signifi cantly with T1D were included; those with a diagnosis of insulin resistance were higher among men (APR, 1.6, 95% CI, 1.3-2.0) and women (APR, 1.8, 95% excluded. Measurements included insulin usage patterns, hypoglycemia, CI, 1.5-2.1) with the condition 15 years or longer than among those with the and hospital and emergency room (ER) visits during follow-up.From 559,041 condition less than 15 years. There were signifi cant associations between people diagnosed with diabetes, 11,378 with T1D (2.0%) were identifi ed time since diagnosis and the cancers of the prostate, colon, skin, and urinary (53% male; mean age, 34 y). Comorbidities included hyperlipidemia (31%), tract among men, and the cancers of the breast, female reproductive tract, hypertension (28%), and mental illness (17%). Co-medications included an- and skin among women. The prevalence estimates for cancers of all sites tihypertensives (64%) and statins (23%). Basal, prandial, and premix insulin was about 1.3 times higher among insulin users than non insulin users for was used by 53, 67, and 7% of patients at baseline and by 72, 87, and 8% both men (APR, 1.3, 95% CI, 1.1-1.7) and women (APR, 1.3, 95% CI, 1.1-1.5). In at follow-up, respectively. The most-used basal insulin was glargine (58%); conclusion, our results suggest that time since diagnosis of diabetes and use aspart (46%) and lispro (39%) were the most-used prandial insulins. Mean of insulin may be associated with increased prevalence of cancer of all sites (SD) doses of glargine, aspart, and lispro at follow-up were 53.5 (34.4), 76.9 and certain types of cancer among adults with diagnosed diabetes. (49.3), and 76.6 (40.1) U, respectively. Hypoglycemia was reported in 17% of the people; 5% were treated in an ER and 2% as inpatients. Hospitalizations Genetics and ER visits for any cause occurred in 24 and 35% of the people; 90 and 68% POSTERS were diabetes-related while diabetes was the primary cause in 56 and 39%, & 1332-P Epidemiology/ respectively.There is a need for better management of people with T1D as Updated Meta-Analysis of Cancer Risk Among Users of Insulin demonstrated by the number of people who experienced hypoglycemia and Glargine diabetes-related hospitalization and ER visits. PETER BOYLE, ALICE KOECHLIN, MATHIEU BONIOL, CHRIS ROBERTSON, GERE- Supported by: sanofi -aventis MIA BOLLI, JULIO ROSENSTOCK, Lyon, France, Glasgow, United Kingdom, Perugia, Italy, Dallas, TX The association between diabetes, its risk factors and treatments, and & 1330-P cancer risk and death has become high on the clinical and research agenda. The Impact of Treatment Non-Compliance on Mortality in People All data regarding cancer risk and use of insulin glargine has been assem- With Type 1 Diabetes bled to perform a meta-analyses performed using state-of-the-art statisti- RICHARD R. RUBIN, MARK PEYROT, CRAIG CURRIE, CHRISTOPHER L. MORGAN, cal methodology. Findings from participating centres in the recent Northern CHRISTOPHER M. BURTON, SARA JENKINS-JONES, CHRIS D. POOLE, MARC EV- European Study have been included. These meta-analyses are based on ANS, Baltimore, MD, Cardiff, United Kingdom, Copenhagen, Denmark reports from epidemiological studies involving a total of 907,008 subjects Little is known about the association between poor treatment compli- and 2,597,602 person-years of observation.Based on independent estimates ance (medication non-compliance and/or non-attendance at medical ap- from 13 studies, for glargine compared to non-glargine insulin, the Summary pointments) and all-cause mortality in people with type 1 diabetes.This is Relative Risk (SRR) for all forms of cancer was (SRR=0.90, 95% CI (0.82, an observational cohort study conducted using data extracted from The 0.99)) and for breast cancer SRR=1.11 (95% CI (1.00, 1.22)). For new users of Health Improvement Network (THIN) research database, comprising data on glargine, from 6 studies, the SRR for breast cancer was SRR=1.30 (95% CI all patients served by over 350 primary care practices in the United Kingdom. (0.93, 1.81)). Based on independent estimates for 8 studies, for colorectal Treatment non-compliance was assessed during routine record keeping by cancer the SRR=0.84 (95% CI (0.74, 0.95)) and for prostate cancer SRR=1.13 care providers without special training in non-compliance assessment. Rela- (95% CI (1.00, 1.28))Overall, the risk of developing cancer among users of in- tive survival during the mortality observation period was compared by deter- sulin glargine is reduced compared to the risk of users of other insulins. Simi- mining the progression to all-cause mortality using a Cox proportional haz- larly, the risk of colorectal cancer appears reduced among users of glargine. ard model. Of 2,946 patients with type 1 diabetes, 867 (29.4%) had a record While above unity, the risks of breast cancer and prostate cancer are in- of either appointment non-attendance or medication non-compliance during creased marginally but are not signifi cantly elevated.Potential limitations to a period of 2.5 years from onset of diabetes to the beginning of the period for this meta-analysis include that the comparison group was not the same in observation of mortality. The crude, unadjusted mortality rate for those pa- all studies but this could also be seen as a strength. The meta-analysis of tients who were treatment non-compliant (encompassing medication non- the randomized trials had several insulin comparators and the retinopathy compliance and appointment non-attendance) compared to those who were study had NPH as the comparator. This is not likely to invalidate the fi ndings treatment compliant was 1.462 (95% CI 0.954-2.205). Following adjustment of this analysis nor would the fact that different adjustments were made in for confounding factors (increased BMI, increased HbA1c, smoking history the individual studies.In conclusion, the current evidence gives no support and number of prior clinic appointments), treatment non-compliance was as- to the hypothesis that insulin glargine is associated with an increased risk sociated with increased all-cause mortality (HR=1.642; 95% CI 1.055-2.554). of cancer as compared to other insulin and gives reassurance to physicians Treatment non-compliance was associated with increased all-cause mortal- and their patients. ity in patients with type 1 diabetes. Understanding and addressing factors that contribute to patient treatment non-compliance will be important in improving the life expectancy of patients with type 1 diabetes. Supported by: Novo Nordisk A/S ADA-Funded Research & Guided Audio Tour poster For author disclosure information, see page 797. A345 EPIDEMIOLOGYCATEGORY 1333-P Guided Audio Tour: Diabetes Diagnosis and Screening (Posters 1335-P to 1342-P), see page 13. WITHDRAWN & 1335-P Impaired Fasting Glucose and Elevated HbA1c: Are Two Better Than One for Predicting Diabetes in Older Adults? KASIA J. LIPSKA, SILVIO E. INZUCCHI, PETER H. VAN NESS, THOMAS M. GILL, ALKA KANAYA, ELSA S. STROTMEYER, ANNEMARIE KOSTER, KAREN C.
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