European Journal of Epidemiology

, Volume 26, Issue 11, pp 863–876 | Cite as

Diabetes mellitus and incidence and mortality of colorectal cancer: a systematic review and meta-analysis of cohort studies

  • Ying JiangEmail author
  • Qiwen Ben
  • Hong Shen
  • Weiqi Lu
  • Yong Zhang
  • Jun Zhu


Increasing evidence suggests that a history of diabetes mellitus (DM) may be associated with an increased risk of colorectal cancer (CRC). To provide a quantitative assessment of the association between DM and risk of CRC, We evaluated the relation between DM and incidence and mortality of CRC in a systematic review of cohort studies. Full publications of cohort studies were identified in MEDLINE, EMBASE and Science Citation Index Expanded, through February 28, 2011. Summary relative risks (SRRs) with 95% confidence intervals (CIs) were summarized using a random-effects model. Between-study heterogeneity was assessed using the Cochran’s Q and I2 statistics. A total of 41 cohort studies (35 articles) were included in this systematic review. Combining 30 cohort studies which presented results on diabetes and CRC incidence, diabetes was associated with an increased incidence of CRC (SRRs 1.27, 95% CI: 1.21–1.34), with evident heterogeneity among studies (P = 0.002, I2 = 48.4%). Subgroup analysis and meta-regression analysis by controlling the confounders showed that the increased incidence of CRC was independent of geographic locations, sex, family history of colorectal cancer, smoking, physical activity and body mass index. Diabetes was also positively associated with CRC mortality (SRR 1.20, 95% CI: 1.03–1.40), with evidence of heterogeneity between studies (P < 0.001, I2 = 81.4%). Results from this systematic review support that compared to non-diabetic individuals, diabetic individuals have an increased risk of CRC.


Colorectal cancer Diabetes mellitus Systematic review Meta-analysis Incidence Mortality 



This work was supported by the National Natural Science Foundation of China (No.30972937; 81072025). This study was not funded by any Pharmaceutical Company.

Conflict of interest


Supplementary material

10654_2011_9617_MOESM1_ESM.doc (30 kb)
Supplementary material 1 (DOC 29 kb)


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Ying Jiang
    • 1
    • 2
    Email author
  • Qiwen Ben
    • 3
  • Hong Shen
    • 4
  • Weiqi Lu
    • 1
  • Yong Zhang
    • 1
  • Jun Zhu
    • 1
  1. 1.Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
  2. 2.Department of General SurgeryAffiliated Hospital of Nantong UniversityNantongChina
  3. 3.Department of GastroenterologyChanghai Hospital of Second Military Medical UniversityShanghaiChina
  4. 4.Department of EmergencyZhongshan Hospital, Fudan UniversityShanghaiChina

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