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Is Metformin Associated with a Lower Prevalence of Polyps, Adenomas, and Colorectal Carcinoma in Patients with Diabetes Mellitus?

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Abstract

Purpose

Recent studies suggested a protective role of metformin in the development of colorectal cancer (CRC) and its precursors. We aimed to investigate if metformin was associated with a lower prevalence and number of colorectal polyps in diabetic patients and also adenomas, high-risk adenomas, and CRC.

Methods

Retrospective study on adult patients with diabetes mellitus followed in our hospital with a total colonoscopy between 2015 and 2019, treated with either metformin for > 5 years or other antidiabetic agent (control group). We assessed the number, size, and histopathology examination of proliferative lesions detected on colonoscopy.

Results

We included 401 patients aged 69 ± 9 years, 57% males, divided into two groups: treated with metformin (n = 260) and without (n = 141). The number of polyps detected was significantly lower in patients under metformin (p = 0.014). There was a nonsignificant trend towards lower polyp detection rates in the metformin compared to the control group both in unadjusted analysis (50% vs 60%, p = 0.058) and multivariable adjusted analysis (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.43–1.09, p = 0.111). In the latter, we identified male gender (OR 2.24, 95%CI 1.44–3.49, p < 0.001), age (OR 1.35 for every 10 years, 95%CI 1.07–1.71, p = 0.012), glycated hemoglobin value (OR 1.20 for every 1% increase, 95%CI 1.06–1.37, p = 0.005), and hypertension (OR 1.76, 95%CI 1.01–3.08, p = 0.046) as factors associated with a higher prevalence of polyps. We saw no statistically significant differences regarding adenoma (p = 0.231), high-risk adenoma (p = 0.810), and CRC (p = 0.705) diagnoses between groups.

Conclusion

In our study, metformin was associated with less colorectal polyps in diabetic patients compared to other treatment modalities. We observed a nonsignificant trend towards lower polyp detection rates in the metformin group both in unadjusted and adjusted analyses.

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Data Availability

The data that support the findings of this study are available upon request from the corresponding author.

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Authors and Affiliations

  1. Gastroenterology Department of Centro Hospitalar Universitário de Lisboa Central, EPE, Lisbon, Portugal

    Maria Inês Canha, Gonçalo Ramos, Rita Prata, Pedro Lages Martins, Marta Viúla Ramos & João Coimbra

  2. NOVA Medical School, Lisbon, Portugal

    Maria Inês Canha, Gonçalo Ramos, Pedro Lages Martins & João Coimbra

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  1. Maria Inês Canha
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Maria Inês Canha was involved in the conception of the work, information gathering and manuscript drafting, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Gonçalo Ramos, Rita Prata, Pedro Lages Martins, Marta Viúla Ramos and João Coimbra made substantial contributions to the conception of the work, critically revised the manuscript, approved its final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Maria Inês Canha.

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Canha, M.I., Ramos, G., Prata, R. et al. Is Metformin Associated with a Lower Prevalence of Polyps, Adenomas, and Colorectal Carcinoma in Patients with Diabetes Mellitus?. J Gastrointest Canc 55, 435–443 (2024). https://doi.org/10.1007/s12029-023-00989-2

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