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Insulin Therapy and Colorectal Adenoma Risk Among Patients with Type 2 Diabetes Mellitus: A Case-Control Study in Korea

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Diseases of the Colon & Rectum

Abstract

Purpose

Patients with Type 2 diabetes mellitus may be at increased colorectal adenoma and cancer risk. Moreover, chronic insulin therapy may increase the risk of colorectal cancer among patients with Type 2 diabetes mellitus. We investigated to determine whether insulin therapy might increase the risk of colorectal adenoma among clinically confirmed patients with Type 2 diabetes mellitus.

Methods

We conducted a retrospective study among patients with Type 2 diabetes mellitus who underwent total colonoscopy between January 2003 and July 2006 at Hallym University Sacred Heart Hospital. Among them (n = 325), patients with histologically confirmed colorectal adenomas (n = 100) and the same number of controls matched by age and sex were selected and analyzed.

Results

Adenoma cases showed significantly higher rate of chronic insulin therapy (more than 1 year) than controls (P = 0.018). In multivariate regression analysis, patients who received chronic insulin therapy had three times the risk of colorectal adenoma compared with patients who received no insulin (odds ratio, 3; 95 percent confidence interval, 1.1–8.9; P = 0.04).

Conclusions

Chronic insulin therapy was associated with increased colorectal adenoma risk among Type 2 diabetes mellitus patients. This result may provide a need for more intensive colorectal cancer screening program in patients with Type 2 diabetes mellitus, especially those who receive chronic insulin therapy.

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References

  1. Jemal A, Murray T, Samuels A, et al. Cancer statistics, 2003. CA Cancer J Clin 2003;53:5-26.

    Article  PubMed  Google Scholar 

  2. Ministry of Health and Social Affairs, Republic of Korea. One year’s report of cancer registry program in the Republic of Korea. July 1, 2000 to June 1, 2001. Seoul: Government Printing Office, 2001.

  3. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993;329:1977-81.

    Article  PubMed  CAS  Google Scholar 

  4. Chao A, Thun MJ, Connell CJ, et al. Meat consumption and risk of colorectal cancer. JAMA 2005;293:172-82.

    Article  PubMed  CAS  Google Scholar 

  5. Giovannucci E. Insulin and colon cancer. Cancer Causes Control 1995;6:164-79.

    Article  PubMed  CAS  Google Scholar 

  6. Tran TT, Medline A, Bruce WR. Insulin promotion of colon tumors in rats. Cancer Epidemiol Biomarkers Prev 1996;5:1013-5.

    PubMed  CAS  Google Scholar 

  7. Schoen RE, Weissfeld JL, Kuller LH, et al. Insulin-like growth factor-I and insulin are associated with the presence and advancement of adenomatous polyps. Gastroenterology 2005;129:4644-75.

    Google Scholar 

  8. Kaaks R, Toniolo P, Akhmedkhanov A, et al. Serum C-peptide, insulin-like growth factor (IGF)-I, IGF-binding proteins, and colorectal cancer risk in women. J Natl Cancer Inst 2000;92:1592-600.

    Article  PubMed  CAS  Google Scholar 

  9. Will JC, Galuska DA, Vinicor F, et al. Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol 1998;147:816-25.

    PubMed  CAS  Google Scholar 

  10. 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;91:542-7.

    Article  PubMed  CAS  Google Scholar 

  11. Yang YX, Hennessy S, Lewis JD. Type 2 diabetes mellitus and the risk of colorectal cancer. Clin Gastroenterol Hepatol 2005;3:587-94.

    Article  PubMed  Google Scholar 

  12. Elwing JE, Gao F, Davidson NO, et al. Type 2 diabetes mellitus: the impact on colorectal adenoma risk in women. Am J Gastroenterol 2006;101:1866-71.

    Article  PubMed  Google Scholar 

  13. Garvey WT, Olefsky JM, Griffin J, et al. The effect of insulin treatment on insulin secretion and insulin action in type II diabetes mellitus. Diabetes 1985;34:222-34.

    Article  PubMed  CAS  Google Scholar 

  14. Anonymous. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-53.

    Article  Google Scholar 

  15. Genuth S. Insulin use in NIDDM. Diabetes Care 1990;13:1240-64.

    Article  PubMed  CAS  Google Scholar 

  16. Yang YX, Hennessy S, Lewis JD. Insulin therapy and colorectal cancer risk among type 2 diabetes mellitus patients. Gastroenterology 2004;127:1044-50.

    Article  PubMed  CAS  Google Scholar 

  17. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.

    PubMed  CAS  Google Scholar 

  18. Sandhu MS, Dunger DB, Giovannucci EL. Insulin, insulin-like growth factor-I (IGF-I), IGF binding proteins, their biologic interactions, and colorectal cancer. J Natl Cancer Inst 2002;94:972-80.

    PubMed  CAS  Google Scholar 

  19. LeRoith D, Baserga R, Helman L, et al. Insulin-like growth factors and cancer. Ann Intern Med 1995;122:54-9.

    PubMed  CAS  Google Scholar 

  20. Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr 2001:131:3109S-20S.

    PubMed  CAS  Google Scholar 

  21. Palmqvist R, Hallmans G, Rinaldi S, et al. Plasma insulin-like growth factor 1, insulin-like growth factor binding protein 3, and risk of colorectal cancer: a prospective study in northern Sweden. Gut 2002;50:642-6.

    Article  PubMed  CAS  Google Scholar 

  22. Renehan AG, Zwahlen M, Minder C, et al. Insulin-like growth factor (IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet 2004;363:1346-53.

    Article  PubMed  CAS  Google Scholar 

  23. Yamagishi S, Nakamura K, Inoue H, et al. Possible participation of advanced glycation end products in the pathogenesis of colorectal cancer in diabetic patients. Med Hypotheses 2005;64:1208-10.

    Article  PubMed  CAS  Google Scholar 

  24. Le Marchand L, Wilkens LR, Kolonel LN, et al. Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res 1997;57:4787-94.

    PubMed  Google Scholar 

  25. 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;91:542-7.

    Article  PubMed  CAS  Google Scholar 

  26. Tomiyama R, Kinjo F, Hokama A, et al. Relationship between diabetes mellitus and the site of colorectal cancer. Am J Gastroenterol 2003;98:944-5.

    Article  PubMed  Google Scholar 

  27. Giovannucci E, Ascherio A, Rimm EB, et al. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 1995;122:327-34.

    PubMed  CAS  Google Scholar 

  28. Martinez ME, Giovannucci E, Spiegelman D, et al. Leisure-time physical activity, body size, and colon cancer in women. Nurses’ Health Study Research Group. J Natl Cancer Inst 1997;89:948-55.

    Article  PubMed  CAS  Google Scholar 

  29. Schoen RE, Tangen CM, Kuller LH, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst 1999;91:1147-54.

    Article  PubMed  CAS  Google Scholar 

  30. Nagel JM, Goke B. Colorectal carcinoma screening in patients with type 2 diabetes mellitus. Z Gastroenterol 2006;44:1153-65.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Hallym University Sacred Heart Hospital, Anyang, South Korea

    Yong Woo Chung M.D., Kwang Hyuk Park M.D., Kyo-Sang Yoo M.D. & Choong Kee Park M.D.

  2. Department of Gastroenterology, Hanyang University Guri Hospital, Guri, South Korea

    Dong Soo Han M.D. & Chang Soo Eun M.D.

Authors
  1. Yong Woo Chung M.D.
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  2. Dong Soo Han M.D.
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  3. Kwang Hyuk Park M.D.
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  4. Chang Soo Eun M.D.
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  5. Kyo-Sang Yoo M.D.
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  6. Choong Kee Park M.D.
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Correspondence to Dong Soo Han M.D..

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Chung, Y.W., Han, D.S., Park, K.H. et al. Insulin Therapy and Colorectal Adenoma Risk Among Patients with Type 2 Diabetes Mellitus: A Case-Control Study in Korea. Dis Colon Rectum 51, 593–597 (2008). https://doi.org/10.1007/s10350-007-9184-1

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  • DOI: https://doi.org/10.1007/s10350-007-9184-1

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