Effect of Obesity and Demographic Factors on Advanced Adenoma Detection Rate Among Type 2 Diabetes Mellitus Patients

Abstract

Introduction: Adenomatous polyps are known precursors of colorectal cancer (CRC). CRC screening recommendations are for individuals with average risk without consideration of special subgroups like diabetic population. There may not be one best screening algorithm, but optimal strategies need to be defined for different population subgroups. We designed our study to measure the effect of race, gender, age, and obesity on advanced adenoma detection rate (AADR) among diabetes mellitus type 2 (DM2) patients. Methods: The retrospective study involved chart review of DM2 patients undergoing outpatient colonoscopy at our center. Only subjects with screening colonoscopy as an indication were included. Subjects with incomplete colonoscopy or with personal history of CRC, IBD, HNPCC, FAP, or colectomy were excluded. Anesthesia, colonoscopy, and pathology reports were reviewed to collect the data related to age, gender, race, weight, height, polyp, adenoma, and advanced adenoma. Based on BMI, the subjects were grouped into 4 categories (1-BMI<25, 2-BMI-25 to 29.9, 3-BMI-30 to 39.9, 4- BMI 40 and above). Binomial logistic regression model was used to analyze the data. Results: Six hundred twenty-three subjects with male to female ratio of 1:1.3 satisfied the inclusion criteria. Ethnically 69.8% were African Americans (AA), 8.2% Whites (W), 10.4% Hispanics (H), 10% Asians (As) and 1.4 % others. AADR was 11.7% for female and 15.8% for male. AADR was 11.3%, 13.1%, 13.8% and 19.6% for As, AA, H and W respectively. AADR was 10.6% for 50-59 years age group, 17.8% for 60-69 years age group and 13.1% for 70-79 years age group (p-value <.05). AADR for category 1, 2, 3, and 4 was 11.9%, 12.4%, 13.8%, and 17.8% respectively (p-value >.05). Conclusion: Males have higher AADR in comparison to females. Whites have a much higher risk for advanced adenoma in comparison to African Americans, Hispanics and Asians in our population. The risk for advanced adenoma increases with age (till 70 years of age) and then trends down. There is a positive correlation between BMI and AADR. Male gender, Age, White race and Obesity increases the risk for CRC precursor lesions among DM2 patients.