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Exogenous Insulin Therapy Is Associated with the Risk of Advanced Colorectal Adenoma in Patients with Diabetes Mellitus

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Abstract

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.

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Acknowledgments

This work was funded by the US VA CSR&D Merit Review Award (I01 CX000211). The funding sponsor had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA

    Robert Lam

  2. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA

    Wei-Ting Hwang & Yu-Xiao Yang

  3. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Wei-Ting Hwang, Ben Boursi & Yu-Xiao Yang

  4. Mount Sinai School of Medicine, New York, NY, USA

    Sumanth Chennareddy

  5. Tel-Aviv University, Tel-Aviv, Israel

    Ben Boursi

  6. Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel

    Ben Boursi

  7. Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Yu-Xiao Yang

  8. Gastrointestinal Section, Medicine Services, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA

    Yu-Xiao Yang

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  1. Robert Lam
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Contributions

Study conception and design: RL, Y-XY. Data collection: RL, Chennareddy, Y-XY. Analysis and interpretation of results: All authors. Drafted or revised manuscript critically: All authors. Reviewed the results and approved the final version of the manuscript: All authors. Agreed to be accountable for all aspects of the work: All authors.

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Correspondence to Yu-Xiao Yang.

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Lam, R., Hwang, WT., Chennareddy, S. et al. Exogenous Insulin Therapy Is Associated with the Risk of Advanced Colorectal Adenoma in Patients with Diabetes Mellitus. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08350-8

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