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Insulin enhances and metformin reduces risk of colorectal carcinoma in type-2 diabetes.
QJM. 2020 Mar 01; 113(3):194-200.QJM

Abstract

BACKGROUND

Identifying colorectal cancer associated risks is important for conducting a program for the survey and prevention of colorectal cancer.

AIM

To investigate the association between use of insulin or metformin with colorectal cancer (CRC) in type 2 diabetes (T2DM).

DESIGN

Population-based cohort study.

METHODS

Through analysis of National Health Insurance (NHI) database between 1998 and 2010 in Taiwan, we identified 66 324 T2DM patients aged ≥ 20 years and selected subjects without diabetes by 1: 1 randomly matching with the study cohort based on age, sex and index date. We followed up the participants until 31 December 2011 or when they withdrew from the NHI program.

RESULTS

Compared with non-diabetic subjects, the T2DM patients exhibited an increased risk of CRC [adjusted HR (aHR) = 1.56, 95% confidence interval (CI) = 1.39-1.75], after adjustment for age, sex, urbanization level, comorbidities and examinations of colonoscopy, sigmoidoscopy, or stool occult blood test. Among the T2DM patients, insulin usage increased the risk of CRC (aHR = 1.86, 95% CI = 1.58-0-2.19) after adjustment for age, sex, urbanization level, comorbidities, metformin usage and examinations; nevertheless, metformin decreased the risk of CRC (aHR = 0.65, 95% CI = 0.54-0.77) after adjustment for age, sex, urbanization level, comorbidities, insulin usage and examinations. Compared with the non-insulin cohort, the risk of CRC tended to increase with the incremental dosage of insulin exposure.

CONCLUSION

Our population-based cohort study demonstrated an association between T2DM and CRC. Among the T2DM patients, insulin use was associated with an increased risk of CRC and metformin use was associated with a decreased risk of CRC. Inability to obtain information on several potential confounding factors, such as lifestyle and dietary habits, is the major limitation of the study.

Authors+Show Affiliations

From the Digestive Disease Center, Changbing Show-Chwan Memorial Hospital 505, Taiwan. Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan.Management Office for Health Data, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan. College of Medicine, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan. Department of Nuclear Medicine and PET Center, and Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan. Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31593243

Citation

Chen, C-H, et al. "Insulin Enhances and Metformin Reduces Risk of Colorectal Carcinoma in Type-2 Diabetes." QJM : Monthly Journal of the Association of Physicians, vol. 113, no. 3, 2020, pp. 194-200.
Chen CH, Lin CL, Hsu CY, et al. Insulin enhances and metformin reduces risk of colorectal carcinoma in type-2 diabetes. QJM. 2020;113(3):194-200.
Chen, C. H., Lin, C. L., Hsu, C. Y., & Kao, C. H. (2020). Insulin enhances and metformin reduces risk of colorectal carcinoma in type-2 diabetes. QJM : Monthly Journal of the Association of Physicians, 113(3), 194-200. https://doi.org/10.1093/qjmed/hcz253
Chen CH, et al. Insulin Enhances and Metformin Reduces Risk of Colorectal Carcinoma in Type-2 Diabetes. QJM. 2020 Mar 1;113(3):194-200. PubMed PMID: 31593243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insulin enhances and metformin reduces risk of colorectal carcinoma in type-2 diabetes. AU - Chen,C-H, AU - Lin,C-L, AU - Hsu,C-Y, AU - Kao,C-H, PY - 2019/07/30/received PY - 2019/09/25/revised PY - 2019/10/9/pubmed PY - 2020/11/28/medline PY - 2019/10/9/entrez SP - 194 EP - 200 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 113 IS - 3 N2 - BACKGROUND: Identifying colorectal cancer associated risks is important for conducting a program for the survey and prevention of colorectal cancer. AIM: To investigate the association between use of insulin or metformin with colorectal cancer (CRC) in type 2 diabetes (T2DM). DESIGN: Population-based cohort study. METHODS: Through analysis of National Health Insurance (NHI) database between 1998 and 2010 in Taiwan, we identified 66 324 T2DM patients aged ≥ 20 years and selected subjects without diabetes by 1: 1 randomly matching with the study cohort based on age, sex and index date. We followed up the participants until 31 December 2011 or when they withdrew from the NHI program. RESULTS: Compared with non-diabetic subjects, the T2DM patients exhibited an increased risk of CRC [adjusted HR (aHR) = 1.56, 95% confidence interval (CI) = 1.39-1.75], after adjustment for age, sex, urbanization level, comorbidities and examinations of colonoscopy, sigmoidoscopy, or stool occult blood test. Among the T2DM patients, insulin usage increased the risk of CRC (aHR = 1.86, 95% CI = 1.58-0-2.19) after adjustment for age, sex, urbanization level, comorbidities, metformin usage and examinations; nevertheless, metformin decreased the risk of CRC (aHR = 0.65, 95% CI = 0.54-0.77) after adjustment for age, sex, urbanization level, comorbidities, insulin usage and examinations. Compared with the non-insulin cohort, the risk of CRC tended to increase with the incremental dosage of insulin exposure. CONCLUSION: Our population-based cohort study demonstrated an association between T2DM and CRC. Among the T2DM patients, insulin use was associated with an increased risk of CRC and metformin use was associated with a decreased risk of CRC. Inability to obtain information on several potential confounding factors, such as lifestyle and dietary habits, is the major limitation of the study. SN - 1460-2393 UR - https://www.unboundmedicine.com/medline/citation/31593243/Insulin_enhances_and_metformin_reduces_risk_of_colorectal_carcinoma_in_type_2_diabetes_ DB - PRIME DP - Unbound Medicine ER -