Use of sulphonylurea in type 2 diabetes mellitus and incident risk of Hepatocellular Carcinoma: Are we safe to prescribe?

While Type 2 Diabetes Mellitus (T2DM) has become a global epidemic over the past few decades along with obesity and metabolic syndrome, there has been increasing evidence showing association between Diabetes and several cancers particularly hepatocellular carcinoma (HCC). HCC has become a prime cause of cancer related mortality across the globe, gaining attention on the potential aetiological factors for carcinogenesis. Insulin resistance and hyperinsulinemia associated with T2DM is postulated as the potential link between HCC and DM, and concerns were raised about the role of anti-diabetic medications particularly insulin and insulin secretagogues in the development of HCC. Despite the development of many anti-diabetic medications with multiple cardiovascular and renal benefits, Sulphonylurea (SU) plays a major role in achieving a good glycemic control among DM population in our part of the world (South-Asia) being widely used as a second line oral hypoglycemic after Metformin. Here, we give a brief review of literature on SU and incident risk of HCC among diabetic population in order to weigh the risk vs benefits for prescribing in patients.