Abstract
BackgroundColorectal cancer (CRC) develops from colorectal adenomatous polyps. This study is to determine if diabetes mellitus (DM), its treatment, and hemoglobin A1c (HbA1c) level are associated with increased risk of colorectal adenomatous polyps.MethodsThis was a retrospective cohort study that included patients who had at least one colonoscopy and were continuously enrolled in a single managed care organization during a 10-year period (2002–2012). Of these patients (N = 11,933), 1800 were randomly selected for chart review to examine the details of colonoscopy and pathology findings and to confirm the diagnosis of DM. Multivariable logistic regression analyses were performed to assess the associations between DM, its treatment, HbA1c level and adenomatous polyps (our main outcome).ResultsAmong the total of 11,933 patients with a mean (standard deviation) age of 56 (± 8.8) years, 2306 (19.3%) had DM and 75 (0.6%) had CRC. Among the 1800 under chart review, 445 (24.7%) had DM, 11 (0.6%) had CRC and 537 (29.8%) had adenomatous polyps. In bivariate analysis, patients with DM had 1.45 odds of developing adenomatous polyps compared to those without DM. This effect was attenuated (odds ratio = 1.25, 95% CI: 0.96–1.62, p = 0.09) after adjusting for confounders such as age, gender, race/ethnicity, and body mass index. There was no significant association between type or duration of DM treatment or HbA1c level and adenomatous polyps.ConclusionsOur study confirmed the known increased risk of adenomatous polyps with advancing age, male gender, Hispanic race/ethnicity and higher body mass index. Although it suggested an association between DM and adenomatous polyps, a statistically significant association was not observed after controlling for other potential confounders. Further studies with a larger sample size are needed to further elucidate this relationship.
Highlights
Colorectal cancer (CRC) develops from colorectal adenomatous polyps
The demographic characteristics of the sample population (n = 1798) were statistically similar to the total Health Alliance Plan (HAP) population except that the prevalence of diabetes mellitus (DM) diagnosis was greater in the sample population compared to total population (n = 11,933) (Table 1)
This is because more patients with DM (25%) were identified by medical record review compared to those identified by Healthcare Effectiveness Data and Information Set (HEDIS) criteria (19%) in the administrative database of HAP population (p < 0.0001) (Table 1)
Summary
Colorectal cancer (CRC) develops from colorectal adenomatous polyps. Screening colonoscopy prevents development of CRC by removal of precursor adenomatous polyps [3]. Since it takes between 7 and 10 years for the precancerous polyp to develop into a malignant lesion, routine screening colonoscopy has been shown to reduce the incidence of CRC and its subsequent morbidity and mortality [4]. Despite advances in CRC screening and treatment modalities, CRC continues to be a leading cause of mortality in the United States. This highlights the need for more targeted interventions
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
