Digestive Diseases and Sciences

, Volume 57, Issue 6, pp 1576–1585 | Cite as

Diabetes Mellitus and the Incidence of Colorectal Cancer: An Updated Systematic Review and Meta-Analysis

  • Longying Deng
  • Zhifu Gui
  • Lianying Zhao
  • Jianping Wang
  • Lizong ShenEmail author



The purpose of this study was to determine whether diabetes mellitus is associated with an increased risk of colorectal cancer.


Relevant studies were identified in MEDLINE and EMBASE (up until November 1st, 2011). Inclusion criteria were original, peer-reviewed publications, with case–control and cohort studies (for studies on diabetes mellitus and colorectal cancer). Summary relative risks with 95% confidence intervals were calculated with a random-effects model.


Twenty-four studies including eight case–control and 16 cohort studies, with a total of 3,659,341 participants, were included in this updated systematic review and meta-analysis, and all involved diabetes mellitus and colorectal cancer risk. Meta-analysis of the 24 included studies indicated that diabetes was associated with an increased risk of colorectal cancer, compared with no diabetes (summary RR of colorectal cancer incidence = 1.26, 95% CI = 1.20–1.31), without heterogeneity between studies (P heterogeneity = 0.296). Sub-group analyses found that these results were consistent between case–control and cohort studies and among studies conducted in different areas. The association between diabetes and colorectal cancer incidence did not differ significantly by sex and sub-sites. Insulin therapy was also positively associated with risk of colorectal cancer (summary RR = 1.61, 95% CI 1.18–1.35), with evidence of heterogeneity between studies (P heterogeneity = 0.014).


Our findings further support a relationship between diabetes and increased risk of colon and rectal cancer in both women and men, and insulin therapy for diabetes may increase this risk.


Diabetes mellitus Colorectal cancer Risk Meta-analysis 



This work was supported by Qing Lan Project and the 7th “Six-Talent-Person-Peak Program,” Jiangsu Province, China. The authors are grateful to Dr. Christopher J. Fleming for his critical review of the manuscript.

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Omran S, Ismail AA. Knowledge and beliefs of Jordanians toward colorectal cancer screening. Cancer Nurs. 2010;33:141–148.PubMedCrossRefGoogle Scholar
  2. 2.
    Giovannucci E, Michaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology. 2007;132:2208–2225.PubMedCrossRefGoogle Scholar
  3. 3.
    Liang PS, Chen TY, Giovannucci E. Cigarette smoking and colorectal cancer incidence and mortality: systematic review and meta-analysis. Int J Cancer. 2009;124:2406–2415.PubMedCrossRefGoogle Scholar
  4. 4.
    Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R. Diabetes and cancer. Endocr Relat Cancer. 2009;16:1103–1123.PubMedCrossRefGoogle Scholar
  5. 5.
    Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053.PubMedCrossRefGoogle Scholar
  6. 6.
    Giovannucci E. Insulin and colon cancer. Cancer Causes Control. 1995;6:164–179.PubMedCrossRefGoogle Scholar
  7. 7.
    McKeown-Eyssen G. Epidemiology of colorectal cancer revisited: are serum triglycerides and/or plasma glucose associated with risk? Cancer Epidemiol Biomarkers Prev. 1994;3:687–695.PubMedGoogle Scholar
  8. 8.
    Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:1679–1687.PubMedCrossRefGoogle Scholar
  9. 9.
    Kuriki K, Hirose K, Tajima K. Diabetes and cancer risk for all and specific sites among Japanese men and women. Eur J Cancer Prev. 2007;16:83–89.PubMedCrossRefGoogle Scholar
  10. 10.
    Inoue M, Iwasaki M, Otani T, Sasazuki S, Noda M, Tsugane S. Diabetes mellitus and the risk of cancer: results from a large-scale population-based cohort study in Japan. Arch Intern Med. 2006;166:1871–1877.PubMedCrossRefGoogle Scholar
  11. 11.
    Seow A, Yuan JM, Koh WP, Lee HP, Yu MC. Diabetes mellitus and risk of colorectal cancer in the Singapore Chinese health study. J Natl Cancer Inst. 2006;98:135–138.PubMedCrossRefGoogle Scholar
  12. 12.
    Khan M, Mori M, Fujino Y, et al. Site-specific cancer risk due to diabetes mellitus history: evidence from the Japan collaborative cohort (JACC) Study. Asian Pac J Cancer Prev. 2006;7:253–259.PubMedGoogle Scholar
  13. 13.
    National Institute of Diabetes and Digestive and Kidney Diseases. National diabetes statistics, 2007 fact sheet. Bethesda: US Department of Health and Human Services, National Institutes of Health; 2008.Google Scholar
  14. 14.
    DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review. JAMA. 2003;289:2254–2264.PubMedCrossRefGoogle Scholar
  15. 15.
    Chung YW, Han DS, Park KH, Eun CS, Yoo KS, Park CK. Insulin therapy and colorectal adenoma risk among patients with type 2 diabetes mellitus: a case–control study in Korea. Dis Colon Rect. 2008;51:593–597.CrossRefGoogle Scholar
  16. 16.
    Yang YX, Hennessy S, Lewis JD. Insulin therapy and colorectal cancer risk among type 2 diabetes mellitus patients. Insulin therapy and colorectal cancer risk among type 2 diabetes mellitus patients. Gastroenterology. 2004;127:1044–1050.PubMedCrossRefGoogle Scholar
  17. 17.
    Currie CJ, Poole CD, Gale EA. The influence of glucose-lowering therapies on cancer risk in type 2 diabetes. Diabetologia. 2009;52:1766–1777.PubMedCrossRefGoogle Scholar
  18. 18.
    Campbell PT, Deka A, Jacobs EJ, et al. Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men. Gastroenterology. 2010;139:1138–1146.PubMedCrossRefGoogle Scholar
  19. 19.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Iniciativa STROBE: the strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Rev Esp Salud Publ. 2008;82:251–259.Google Scholar
  20. 20.
    O’Mara BA, Byers T, Schoenfeld E. Diabetes mellitus and cancer risk: a multisite case–control study. J Chronic Dis. 1985;38:435–441.PubMedCrossRefGoogle Scholar
  21. 21.
    Kune GA, Kune S, Watson LF. Colorectal cancer risk, chronic illnesses, operations, and medications: case control results from the Melbourne colorectal cancer study. Cancer Res. 1988;48:4399–4404.PubMedGoogle Scholar
  22. 22.
    Le Marchand L, Wilkens LR, Kolonel LN, Hankin JH, Lyu LC. Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res. 1997;57:4787–4794.PubMedGoogle Scholar
  23. 23.
    La Vecchia C, Negri E, Decarli A, Franceschi S. Diabetes mellitus and colorectal cancer risk. Cancer Epidemiol Biomarkers Prev. 1997;6:1007–1010.PubMedGoogle Scholar
  24. 24.
    Levi F, Pasche C, Lucchini F, La Vecchia C. Diabetes mellitus, family history, and colorectal cancer. J Epidemiol Community Health. 2002;56:479–480. Author reply 480.PubMedCrossRefGoogle Scholar
  25. 25.
    Yang YX, Hennessy S, Lewis JD. Type 2 diabetes mellitus and the risk of colorectal cancer. Clin Gastroenterol Hepatol. 2005;3:587–594.PubMedCrossRefGoogle Scholar
  26. 26.
    Vinikoor LC, Long MD, Keku TO, Martin CF, Galanko JA, Sandler RS. The association between diabetes, insulin use, and colorectal cancer among Whites and African Americans. Cancer Epidemiol Biomarkers Prev. 2009;18:1239–1242.PubMedCrossRefGoogle Scholar
  27. 27.
    Steenland K, Nowlin S, Palu S. Cancer incidence in the national health and nutrition survey I. Follow-up data: diabetes, cholesterol, pulse and physical activity. Cancer Epidemiol Biomarkers Prev. 1995;4:807–811.PubMedGoogle Scholar
  28. 28.
    Will JC, Galuska DA, Vinicor F, Calle EE. Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol. 1998;147:816–825.PubMedCrossRefGoogle Scholar
  29. 29.
    Hu FB, Manson JE, Liu S, et al. Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst. 1999;91:542–547.PubMedCrossRefGoogle Scholar
  30. 30.
    Schoen RE, Tangen CM, Kuller LH, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst. 1999;91:1147–1154.PubMedCrossRefGoogle Scholar
  31. 31.
    Nilsen TI, Vatten LJ. Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer. 2001;84:417–422.PubMedCrossRefGoogle Scholar
  32. 32.
    Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. 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 Epidemiol Biomarkers Prev. 2004;13:915–919.PubMedGoogle Scholar
  33. 33.
    Limburg PJ, Anderson KE, Johnson TW, et al. Diabetes mellitus and subsite-specific colorectal cancer risks in the Iowa women’s health study. Cancer Epidemiol Biomarkers Prev. 2005;14:133–137.PubMedGoogle Scholar
  34. 34.
    Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM. Fasting serum glucose level and cancer risk in Korean men and women. JAMA. 2005;293:194–202.PubMedCrossRefGoogle Scholar
  35. 35.
    Larsson SC, Giovannucci E, Wolk A. Diabetes and colorectal cancer incidence in the cohort of Swedish men. Diabetes Care. 2005;28:1805–1807.PubMedCrossRefGoogle Scholar
  36. 36.
    Flood A, Strayer L, Schairer C, Schatzkin A. Diabetes and risk of incident colorectal cancer in a prospective cohort of women. Cancer Causes Control. 2010;21:1277–1284.PubMedCrossRefGoogle Scholar
  37. 37.
    He J, Stram DO, Kolonel LN, Henderson BE, Le Marchand L, Haiman CA. The association of diabetes with colorectal cancer risk: the multiethnic cohort. Br J Cancer. 2010;103:120–126.PubMedCrossRefGoogle Scholar
  38. 38.
    Li C, Balluz LS, Ford ES, Okoro CA, Tsai J, Zhao G. Association between diagnosed diabetes and self-reported cancer among US adults. Diabetes Care. 2011;34:1365–1368.PubMedCrossRefGoogle Scholar
  39. 39.
    Boffetta P, McLerran D, Chen Y, et al. Body mass index and diabetes in Asia: a cross-sectional pooled analysis of 900,000 individuals in the Asia cohort consortium. PLoS One. 2011;6:e19930.PubMedCrossRefGoogle Scholar
  40. 40.
    Levi Z, Kark JD, Barchana M, et al. Measured body mass index in adolescence and the incidence of colorectal cancer in a cohort of 1.1 million males. Cancer Epidemiol Biomarkers Prev. 2011;20:2524–2531.PubMedCrossRefGoogle Scholar
  41. 41.
    Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. CA Cancer J Clin. 2010;60:207–221.PubMedCrossRefGoogle Scholar
  42. 42.
    Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr. 2001;131:3109S–3120S.PubMedGoogle Scholar
  43. 43.
    Le Roith D. Seminars in medicine of the Beth Israel deaconess medical center: insulin-like growth factors. N Engl J Med. 1997;336:633–640.PubMedCrossRefGoogle Scholar
  44. 44.
    Macaulay VM. Insulin-like growth factors and cancer. Br J Cancer. 1992;65:311–320.PubMedCrossRefGoogle Scholar
  45. 45.
    Bach LA, Rechler MM. Insulin-like growth factors and diabetes. Diabetes Metab Rev. 1992;8:229–257.PubMedCrossRefGoogle Scholar
  46. 46.
    Wolf I, Sadetzki S, Catane R, Karasik A, Kaufman B. Diabetes mellitus and breast cancer. Lancet Oncol. 2005;6:103–111.PubMedCrossRefGoogle Scholar
  47. 47.
    Smith CJ, McKay GA, Fisher M. Diabetes, colorectal cancer and cyclooxygenase 2 inhibition. Int J Clin Pract. 2008;62:810–815.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Longying Deng
    • 1
  • Zhifu Gui
    • 1
  • Lianying Zhao
    • 2
  • Jianping Wang
    • 1
  • Lizong Shen
    • 1
    Email author
  1. 1.Division of Gastrointestinal Surgery, Department of General Surgery, First Affiliated HospitalNanjing Medical UniversityNanjingPeople’s Republic of China
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthNanjing Medical UniversityNanjingPeople’s Republic of China

Personalised recommendations