Type 2 diabetes mellitus and risk of colorectal adenoma: a meta-analysis of observational studies

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Abstract

Background

To summarize the relationship between type 2 diabetes mellitus (T2DM) and risk of colorectal adenomas (CRA), we performed a meta-analysis of observational studies.

Methods

To find studies, we searched PubMed, Embase, the Cochrane Library, Web of Science and conference abstracts and related publications for American Society of Clinical Oncology and the European Society of Medical Oncology. Studies that reported relative risks (RRs) or odds ratios (ORs) with 95 % confidence intervals (CIs) for the association between T2DM and risk of CRA were included. The meta-analysis assessed the relationships between T2DM and risk of CRA. Sensitivity analyses were performed in two ways: (1) by omitting each study iteratively and (2) by keeping high-quality studies only. Publication bias was detected by Egger’s and Begg’s tests and corrected using the trim and fill method.

Results

This meta-analysis included 17 studies with 28,999 participants and 6798 CRA cases. We found that T2DM was a risk factor for CRA (RR: 1.52; 95 % CI: 1.29–1.80), and also for the advanced adenoma (RR: 1.41; 95 % CI: 1.06–1.87). Patients with existing T2DM (RR: 1.56; 95 % CI: 1.16–2.08) or newly diagnosed T2DM (RR: 1.51; 95 % CI: 1.16–1.97) have a risk of CRA. Similar significant results were found in retrospective studies (RR: 1.57; 95 % CI: 1.30–1.89) and population based cross-sectional studies (RR: 1.46; 95 % CI: 1.21–1.89), but not in prospective studies (RR: 1.27; 95 % CI: 0.77–2.10).

Conclusions

Our results suggested that T2DM plays a risk role in the risk of developing CRA. Consequently, medical workers should increase the rate of CRA screening for T2DM patients so that they can benefit from behavioural interventions that can help prevent the development of colorectal cancer. Additional, large prospective cohort studies are needed to make a more convincing case for these associations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2685-3) contains supplementary material, which is available to authorized users.

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Risk Factors Contributing to Type 2 Diabetes and Recent Advances in the Treatment and Prevention

Yanling Wu, Yanping Ding, Yoshimasa Tanaka … (2014)

Type 2 diabetes is a serious and common chronic disease resulting from a complex inheritance-environment interaction along with other risk factors such as obesity and sedentary lifestyle. Type 2 diabetes and its complications constitute a major worldwide public health problem, affecting almost all populations in both developed and developing countries with high rates of diabetes-related morbidity and mortality. The prevalence of type 2 diabetes has been increasing exponentially, and a high prevalence rate has been observed in developing countries and in populations undergoing “westernization” or modernization. Multiple risk factors of diabetes, delayed diagnosis until micro- and macro-vascular complications arise, life-threatening complications, failure of the current therapies, and financial costs for the treatment of this disease, make it necessary to develop new efficient therapy strategies and appropriate prevention measures for the control of type 2 diabetes. Herein, we summarize our current understanding about the epidemiology of type 2 diabetes, the roles of genes, lifestyle and other factors contributing to rapid increase in the incidence of type 2 diabetes. The core aims are to bring forward the new therapy strategies and cost-effective intervention trials of type 2 diabetes.

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Some factors related to Westernization or industrialization increase risk of colon cancer. It is believed widely that this increase in risk is related to the direct effects of dietary fat and fiber in the colonic lumen. However, the fat and fiber hypotheses, at least as originally formulated, do not explain adequately many emerging findings from recent epidemiologic studies. An alternative hypothesis, that hyperinsulinemia promotes colon carcinogenesis, is presented here. Insulin is an important growth factor of colonic epithelial cells and is a mitogen of tumor cell growth in vitro. Epidemiologic evidence supporting the insulin/colon-cancer hypothesis is largely indirect and based on the similarity of factors which produce elevated insulin levels with those related to colon cancer risk. Specifically, obesity--particularly central obesity, physical inactivity, and possibly a low dietary polyunsaturated fat to saturated fat ratio--are major determinants of insulin resistance and hyperinsulinemia, and appear related to colon cancer risk. Moreover, a diet high in refined carbohydrates and low in water-soluble fiber, which is associated with an increased risk of colon cancer, causes rapid intestinal absorption of glucose into the blood leading to postprandial hyperinsulinemia. The combination of insulin resistance and high glycemic load produces particularly high insulin levels. Thus, hyperinsulinemia may explain why obesity, physical inactivity, and a diet low in fruits and vegetables and high in red meat and extensively processed foods, all common in the West, increase colon cancer risk.

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A Srivastava, C. Tripathi (2006)

Diabetes mellitus has now assumed epidemic proportions in many countries of the world. With the present population of 19.4 million diabetics, and approximately 60 million by the year 2025, India would rank first in its share of the global burden of diabetes. Diabetes mellitus is characterized by derangement in carbohydrate, protein, and fat metabolism caused by complete or relative insufficiency of insulin secretion and/or insulin action. There are two main forms of diabetes, type 1 (insulin-dependent diabetes mellitus) and type 2 (non-insulin-dependent diabetes mellitus). Insulin sensitizers (thiazolidinediones), new-generation insulin secretagogue (glimepiride), acarbose, and designer insulin (lispro and aspart) have enormously helped in achieving better metabolic control. Despite the great strides that have been made in the understanding and management of type 2 diabetes, insulin resistance and diabetes-related complications are increasing unabated. The present review not only updates our knowledge in delineating the molecular mechanism(s) causal to insulin sensitivity or resistance, but also provides clues for the prognosis of diabetes and its better management.

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Author and article information

Contributors

Jia He: +86-21-81871441 , hejia63@yeah.net

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 17 August 2016

Publication date PMC-release: 17 August 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 642

Affiliations

[1 ]Medical Service Research Division, Navy Medical Research Institute, Shanghai, China

[2 ]Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433 China

[3 ]Department of Colorectal Surgery, Changhai Hospital, Shanghai, China

[4 ]College of Art & Science, University of San Francisco, San Francisco, USA

Article

Publisher ID: 2685

DOI: 10.1186/s12885-016-2685-3

PMC ID: 4989384

PubMed ID: 27535548

SO-VID: 6ba6f9c4-6a65-4b37-8c36-06a09cfc174e

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 1 November 2014

Date accepted : 5 August 2016

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: type 2 diabetes mellitus,colorectal adenoma,meta-analysis

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: type 2 diabetes mellitus, colorectal adenoma, meta-analysis

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Type 2 diabetes mellitus and risk of colorectal adenoma: a meta-analysis of observational studies

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Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

Related collections

Karger: Oncology

Most cited references 50

Risk Factors Contributing to Type 2 Diabetes and Recent Advances in the Treatment and Prevention

Insulin and colon cancer.

Diabetes mellitus: complications and therapeutics.

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