Background/Aims

Exogenous insulin therapy increases systemic exposure to insulin which may promote the development of colorectal neoplasia. We sought to evaluate the association between exogenous insulin therapy and the incidence of advanced adenoma in type 2 diabetes mellitus.

Methods

A retrospective cohort study was conducted from January 1, 2007, to January 1, 2018, in a regional health system serving the United States Philadelphia metropolitan area, Central New Jersey, and South Central Pennsylvania. Study patients consisted of a random sample of patients with type 2 diabetes mellitus aged 40–80 years who had undergone two rounds of colonoscopy examinations.

The exposure was cumulative duration of insulin therapy (i.e., no use, 1–365 days and > 365 days). The outcome was time to incident advanced adenoma.

Results

Of the 975 eligible patients, 184 patients accumulated > 365 days of insulin therapy before the follow-up colonoscopy. The mean (standard deviation) duration between the two rounds of colonoscopy examination was 5.1 (2.9) years among the insulin users and 5.3 (3.9) years among non-users. Compared to no insulin exposure, receiving > 365 days of insulin therapy was associated with an increased incidence of advanced adenoma (adjusted hazard ratio [aHR] 4.84, 95% confidence interval [CI] 2.82–8.30), right-sided advanced adenoma (aHR 5.48, 95% CI 2.90–10.35), and 3 or more adenomas (aHR 2.61, 95% CI 1.46–4.69) at the follow-up colonoscopy examination.

Conclusion

Insulin therapy is associated with an increased risk of advanced adenoma and may serve as a novel risk-stratification factor to enhance the efficiency of existing colorectal cancer screening and surveillance programs.

Graphical Abstract

中文翻译：

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外源性胰岛素治疗与糖尿病患者晚期结直肠腺瘤的风险相关

背景/目标

外源性胰岛素治疗会增加胰岛素的全身暴露，这可能促进结直肠肿瘤的发展。我们试图评估外源性胰岛素治疗与 2 型糖尿病晚期腺瘤发生率之间的关系。

方法

一项回顾性队列研究于2007年1月1日至2018年1月1日在服务于美国费城都会区、新泽西州中部和宾夕法尼亚州中南部的地区卫生系统中进行。研究患者由年龄为 40-80 岁的 2 型糖尿病患者随机抽取，他们接受了两轮结肠镜检查。

暴露量是胰岛素治疗的累积持续时间（即未使用、1-365 天和> 365 天）。结果是发生晚期腺瘤的时间。

结果

在 975 名符合条件的患者中，有 184 名患者在随访结肠镜检查前累计接受胰岛素治疗超过 365 天。胰岛素使用者两轮结肠镜检查之间的平均（标准差）持续时间为 5.1（2.9）年，非使用者为 5.3（3.9）年。与未暴露胰岛素相比，接受 > 365 天的胰岛素治疗与晚期腺瘤的发病率增加相关（调整后的风险比 [aHR] 4.84，95% 置信区间 [CI] 2.82–8.30）、右侧晚期腺瘤 (aHR) 5.48，95% CI 2.90–10.35），以及在后续结肠镜检查中出现 3 个或更多腺瘤（aHR 2.61，95% CI 1.46–4.69）。

结论

胰岛素治疗与晚期腺瘤的风险增加有关，并且可以作为一种新的风险分层因素，以提高现有结直肠癌筛查和监测计划的效率。

图形概要