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. 2020 Apr;9(4):2884-2894.
doi: 10.21037/tcr.2020.03.36.

Type 2 diabetes mellitus does not increase the risk of multiple myeloma: a systematic review and meta-analysis

Chenlu Zhang #  1 , Yuou Sha #  2 , Haiyan Liu #  1 , Dan Guo  1 , Yijing Jiang  1 , Lemin Hong  1 , Lili Shi  3 , Hongming Huang  1
Affiliations

Type 2 diabetes mellitus does not increase the risk of multiple myeloma: a systematic review and meta-analysis

Chenlu Zhang et al. Transl Cancer Res. 2020 Apr.

Abstract

Background: Epidemiological studies have shown that patients with type 2 diabetes mellitus (T2DM) are at a higher risk of secondary tumors. However, no consensus has been made about whether T2DM can increase the risk of multiple myeloma (MM).

Methods: We searched the databases of PubMed, Cochrane Library and EMBASE and cross-checked the bibliography. Data quality was assessed using the Newcastle-Ottawa scale (NOS). Heterogeneity was calculated as the odds ratio (OR) using a random-effects model. Data were analyzed using Stata version 12.0 software.

Results: A total of 13 articles were selected into this meta-analysis. Initially, we found that diabetic patients had a higher risk of myeloma than non-diabetic patients (OR =1.60, 95% CI: 1.13-2.26, I2=98%, P=0.000). But the data in these articles were highly heterogeneous (I2>75%). Therefore, eight of the included articles showed a moderate heterogeneity (I2=71.6%). We used Galbraith heterogeneity map to analyze the causes of heterogeneity. Two articles with high heterogeneity were excluded. Then, we found the heterogeneity of the left six articles was reduced from moderate to mild (I2=45.9%, P=0.100). The final results of this meta-analysis showed that T2DM was not a risk factor for increased incidence of MM (OR =1.05, 95% CI: 0.83-1.33, I2=45.9%, P=0.100). Also, the subgroup analysis (case-control studies vs. cohort studies) showed no statistical difference (OR =1.19, 95% CI: 0.76-1.85, I2=1%, P=0.364; OR =1.00, 95% CI: 0.75-1.33, I2=71.2%, P=0.031; respectively).

Conclusions: T2DM is not a risk factor for the increased incidence of MM, a finding that should be validated with more strictly designed randomized controlled trials (RCTs).

Keywords: Meta-analysis; carcinogenic risk; multiple myeloma (MM); type 2 diabetes mellitus (T2DM).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2020.03.36). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Results of the literature search.
Figure 2
Figure 2
Odds ratio (OR) of myeloma for patients with diabetes compared with control subjects (patients without diabetes).
Figure 3
Figure 3
Sensitivity analysis of each included study. (A) The first analysis; (B) the second analysis; (C) the third analysis; (D) the forth analysis.
Figure 4
Figure 4
Galbraith heterogeneity of each included study.
Figure 5
Figure 5
Sensitivity analysis of each included study.
Figure 6
Figure 6
Odds ratio (OR) of myeloma for patients with diabetes compared with control subjects (patients without diabetes).
Figure 7
Figure 7
Odds ratio (OR) of myeloma for patients with diabetes in different study types.
Figure 8
Figure 8
Begg’s funnel plots of the publication bias.
Figure S1
Figure S1
Sensitivity analysis of each included study.
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