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 JCT  Vol.3 No.6 A , November 2012
Diabetes Mellitus and Colorectal Neoplasia
Abstract: Background: Many studies have provided evidence for an association between obesity, physical inactivity, and western diet as risk factors for colorectal cancer (CRC). Few studies directly address the association between type 2 Diabetes Mellitus (DM) and the risk of colorectal lesions at specific anatomic locations. Methods: 2663 subjects with a previous history of adenoma (s) and removal of all current adenomas at study entry were followed for a mean time of three years across three different chemoprevention clinical trials. The primary endpoint was colorectal adenoma recurrence and number of lesions during the treatment phase; the secondary endpoints were presence of advanced colorectal neoplasia (CRN) and location of CRN. Using log linear regression, the effect of DM status on the relative risk (RR) of CRN recurrence, advanced CRN, and location of CRN was assessed. Results: DM status was not significantly associated with incidence of colorectal adenomas, incidence of advanced colorectal lesions, or left-sided colorectal neoplastic lesions. Subjects with DM had a marginally increased risk of right-sided (p = 0.06) colorectal adenomas and a significant increased risk of multiple right-sided adenomas (p = 0.03) in the unadjusted model; this association was not significant after adjusting for age and other potential confounders (RR = 1.22, 95% CI: 0.85 - 1.76). Conclusion: We did not observe a statistically significant increased risk in CRN recurrence for overall neoplasia, advanced neoplasia or location of neoplasia in individuals with DM compared to non-DM individuals. However, given the patterns observed in this investigation, future studies with longer follow-up time and longer DM exposure, incorporating objective measurements of type 2 DM might help elucidate the risk of CRN among individuals with DM.
Cite this paper: A. Acevedo, Y. Diaz, C. Perez, M. Garau, J. Baron and M. Cruz-Correa, "Diabetes Mellitus and Colorectal Neoplasia," Journal of Cancer Therapy, Vol. 3 No. 6, 2012, pp. 859-865. doi: 10.4236/jct.2012.326110.
References

[1]   A. Jemal, R. Siegel, J. Xu and E. Ward, “Cancer Statistics,” 2010. CA: A Cancer Journal for Clinicians, Vol. 60, 5, No. 22010, pp. 77-300. doi:10.3322/caac.20073

[2]   J. E. Shaw, R. A. Sicree and P. Z. Zimmet, “Global Estimates of the Prevalence of Diabetes for 2010 and 2030,” Diabetes Research and Clinical Practice, Vol. 87, No. 1, 2010, pp. 4-14. doi:10.1016/j.diabres.2009.10.007

[3]   National Diabetes Fact Sheet, “General Information and National Estimates on Diabetes in the United States, 2007,” In: G. A. Atlanta, Ed., Centers for Disease Control and Prevention, US Department of Health and Human Services, 2008.

[4]   P. J. Limburg, R. A. Vierkant, Z. S. Fredericksen, C. L. Leibson, R. A. Rizza, A. K. Gupta, D. A. Ahlquist, L. J. Melton 3rd, T. A. Sellers and J. R. Cerhan, “Clinically Confirmed Type 2 Diabetes Mellitus and Colorectal Cancer Risk: A Population-Based, Retrospective Cohort Study,” The American Journal of Gastroenterology, Vol. 101, No. 8, 2006, pp. 1872-1879. doi:10.1111/j.1572-0241.2006.00725.x

[5]   T. I. Nilsen and L. J. Vatten, “Prospective Study of Colorectal Cancer Risk and Physical Activity, Diabetes, Blood Glucose and BMI: Exploring the Hyperinsulinaemia Hypothesis,” British Journal of Cancer, Vol. 84, No. 3, 2001, pp. 417-422. doi:10.1054/bjoc.2000.1582

[6]   P. T. Campbell, A. Deka, E. J. Jacobs, C. C. Newton, J. S. Hildebrand, M. L. McCullough, P. J. Limburg and S. M. Gapstur, “Prospective Study Reveals Associations Between Colorectal Cancer and Type 2 Diabetes Mellitus or Insulin Use in Men,” Gastroenterology, Vol. 139, No. 4, 2010, pp. 1138-1146. doi:10.1053/j.gastro.2010.06.072

[7]   S. C. Larsson, N. Orsini and A. Wolk, “Diabetes Mellitus and Risk of Colorectal Cancer: A Meta-Analysis,” Journal of the National Cancer Institute, Vol. 97, No. 22, 2005, pp. 1679-1687. doi:10.1093/jnci/dji375

[8]   Y. X. Yang, S. Hennessy and J. D. Lewis, “Type 2 Diabetes Mellitus and the Risk of Colorectal Cancer,” Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association, Vol. 3, No. 6, 2005, pp. 587-594.

[9]   K. T. Khaw, N. Wareham, S. Bingham, R. Luben, A. Welch and N. Day, “Preliminary Communication: Glycated Hemoglobin, Diabetes, and Incident Colorectal Cancer in Men and Women: A Prospective Analysis From the European Prospective Investigation into Cancer-Norfolk Study,” Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, Vol. 13, No. 6, 2004, pp. 915-919.

[10]   P. J. Limburg, K. E. Anderson, T. W. Johnson, D. R. Jacobs Jr., D. Lazovich, C. P. Hong, K. K. Nicodemus and A. R. Folsom, “Diabetes Mellitus and Subsite-Specific Colorectal Cancer Risks in the Iowa Women’s Health Study,” Cancer epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, Vol. 14, No. 1, 2005, pp. 133-137.

[11]   L. Le Marchand, L. R. Wilkens, L. N. Kolonel, J. H. Hankin and L. C. Lyu, “Associations of Sedentary Lifestyle, Obesity, Smoking, Alcohol Use, and Diabetes with the Risk of Colorectal Cancer,” Cancer Research, Vol. 57, No. 21, 1997, pp. 4787-4794.

[12]   K. Bowers, D. Albanes, P. Limburg, P. Pietinen, P. R. Taylor, J. Virtamo and R. Stolzenberg-Solomon, “A Prospective Study of Anthropometric and Clinical Measurements Associated with Insulin Resistance Syndrome and Colorectal Cancer in Male Smokers,” American Journal of Epidemiology, Vol. 164, No. 7, 2006, pp. 652-664. doi:10.1093/aje/kwj253

[13]   E. R. Greenberg, J. A. Baron, T. D. Tosteson, D. H. Freeman Jr., G. J. Beck, J. H. Bond, T. A. Colacchio, J. A .Coller, H. D. Frankl, R. W. Haile, et al., “A Clinical Trial of Antioxidant Vitamins To Prevent Colorectal Adenoma. Polyp Prevention Study Group,” The New England Journal of Medicine, Vol. 331, No. 3, 1994, pp. 141-147. doi:10.1056/NEJM199407213310301

[14]   J. A. Baron, M. Beach, J. S. Mandel, R. U. van Stolk, R. W. Haile, R. S. Sandler, R. Rothstein, R. W. Summers, D. C. Snover, G. J. Beck, et al., “Calcium Supplements for the Prevention of Colorectal Adenomas. Calcium Polyp Prevention Study Group,” The New England Journal of Medicine, Vol. 340, No. 2, 1999, pp. 101-107. doi:10.1056/NEJM199901143400204

[15]   J. A. Baron, B. F. Cole, R. S. Sandler, R. W. Haile, D. Ahnen, R. Bresalier, G. McKeown-Eyssen, R.W. Summers, R. Rothstein, C. A. Burke, et al., “A Randomized Trial of Aspirin to Prevent Colorectal Adenomas,” The New England Journal of Medicine, Vol. 348, No. 10, 2003, 891-899. doi:10.1056/NEJMoa021735

[16]   E. Torlakovic, E. Skovlund, D. C. Snover, G. Torlakovic and J. M. Nesland, “Morphologic Reappraisal of Serrated Colorectal Polyps,” The American Journal of Surgical Pathology, Vol. 27, No. 1, 2003, pp. 65-81. doi:10.1097/00000478-200301000-00008

[17]   G. Block, A. M. Hartman, C. M. Dresser, M. D. Carroll, J. Gannon and L. Gardner, “A Data-Based Approach to Diet Questionnaire Design and Testing,” American Journal of Epidemiology, Vol. 124, No. 3, 1986, pp. 453-469.

[18]   G. Block, M. Woods, A. Potosky and C. Clifford, “Validation of A Self-Administered Diet History Questionnaire Using Multiple Diet Records,” Journal of Clinical Epidemiology, Vol. 43, No. 12, 1990, pp. 1327-1335. doi:10.1016/0895-4356(90)90099-B

[19]   J. Sobell, G. Block, P. Koslowe, J. Tobin and R. Andres, “Validation of a Retrospective Questionnaire Assessing Diet 10-15 Years Ago,” American Journal of Epidemiology, Vol. 130, No. 1, 1989, pp. 173-187.

[20]   A. F. Subar, F. E. Thompson, V. Kipnis, D. Midthune, P. Hurwitz, S. McNutt, A. McIntosh and S. Rosenfeld, “Comparative Validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: The Eating at America’s Table Study,” American Journal of Epidemiology, Vol. 154, No. 12, 2001, pp. 1089-1099. doi:10.1093/aje/154.12.1089

[21]   V. A. Ezzat, E. R. Duncan, S. B. Wheatcroft and M. T. Kearney, “The Role of IGF-I and Its Binding Proteins in the Development of Type 2 Diabetes and Cardiovascular Disease,” Diabetes, Obesity and Metabolism, Vol. 10, No. 3, 2008, pp. 198-211. doi:10.1111/j.1463-1326.2007.00709.x

[22]   J. E. Elwing, F. Gao, N. O. Davidson and D. S. Early, “Type 2 Diabetes Mellitus: The Impact on Colorectal Adenoma Risk in Women,” The American Journal of Gastroenterology, Vol. 101, No. 8, 2006, pp. 1866-1871. doi:10.1111/j.1572-0241.2006.00651.x

[23]   J. A. Baron, M. Beach, J. S. Mandel, R. U. van Stolk, R. W. Haile, R. S. Sandler, R. Rothstein, R. W. Summers, D. C. Snover, G. J. Beck, et al., “Calcium Supplements and Colorectal Adenomas. Polyp Prevention Study Group,” Annals of the New York Academy of Sciences, Vol. 889, 1999, pp. 138-145. doi:10.1111/j.1749-6632.1999.tb08731.x

[24]   R. S. Sandler, S. Halabi, J. A. Baron, S. Budinger, E. Paskett, R. Keresztes, N. Petrelli, J. M. Pipas, D. D. Karp, C. L. Loprinzi, et al., “A Randomized Trial of Aspirin to Prevent Colorectal Adenomas in Patients with Previous Colorectal Cancer,” The New England Journal of Medicine, Vol. 348, No. 10, 2003, pp. 883-890. doi:10.1056/NEJMoa021633

 
 
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