Type 2 diabetes impacts colorectal adenoma detection in screening colonoscopy

Abstract

Background: Diabetes is associated with an increased risk of colorectal cancer (CRC). We conducted a retrospective analysis of adenoma detection rates (ADR) in initial screening colonoscopies to further investigate the role of diabetes in adenoma detection. Methods: A chart review was performed on initial average risk screening colonoscopies (ages 45–75) during 2012–2015. Data collected included basic demographics, insurance, BMI, family history of CRC, smoking, diabetes, and aspirin use. Multivariable generalized linear mixed models for binary outcomes were used to examine the relationship between diabetes and variables associated with CRC risk and ADR. Results: Of 2865 screening colonoscopies, 282 were performed on patients with type 2 diabetes (T2DM). Multivariable analysis suggested that T2DM (OR = 1.49, 95% CI:1.13–1.97, p = 0.0047) was associated with an increased ADR, as well as smoking, older age, higher BMI and male sex (all p < 0.05). For patients with T2DM, those not taking diabetes medications were more likely to have an adenoma than those taking medication (OR = 2.38, 95% CI:1.09–5.2, p = 0.03). Conclusion: T2DM has an effect on ADR after controlling for multiple confounding variables. Early interventions for prevention of T2DM and prescribing anti-diabetes medications may reduce development of colonic adenomas and may contribute to CRC prevention.

Epidemiology and risk factors of colorectal cancer in China

“…Epidemiological statistics and meta-analysis results showed that patients with T2DM had a higher risk of CRC ( 53 ). Accordingly, timely administration of drugs to control blood glucose in these patients was helpful in reducing the incidence of colorectal adenoma ( 54 ). A recent report from Sweden’s large-scale epidemiological statistics, including 12,614,256 individuals (comprising 559,375 patients with diabetes and 162,226 patients with CRC), followed up between 1964−2015 showed that a personal diabetes history increases the risk of CRC (0.4%) comparably with a family history of CRC (0.5%) in patients diagnosed with diabetes at <50 years old ( 55 ).…”

Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations

“…Patients who underwent index screening colonoscopies at Kings County Hospital from January 1, 2017, until December 31, 2018, were identified using endoscopy reporting software. Patients aged < 45 years or > 75 years or with a history of previous colonoscopy, a history of inflammatory bowel diseases, known hereditary colorectal syndromes, detection of microscopic or macroscopic blood in stool and other alarm syndromes, or detection of colonic masses or polyps in previous studies were excluded from this analysis as previously described[ 14 , 15 ]. Colonoscopies that were incomplete (did not reach the cecum) and those associated with poor bowel preparation were also excluded.…”

“…Colonoscopies that were incomplete (did not reach the cecum) and those associated with poor bowel preparation were also excluded. Clinical metadata were manually collected on each patient using electronic medical records (EMRs) as documented at the time of screening colonoscopy and included (1) age at time of initial screening colonoscopy (year); (2) sex (Male, Female); (3) race (White/EA, Black/AA, Asian, Other); (4) Hispanic ethnicity; (5) Insurance (Commercial, Medicare, Medicaid, Self-pay); (6) BMI (kg/m 2 ); and (7) Tobacco Exposure (Current within one year, Past greater than one year, Never)[ 14 , 15 ]. A family history of a first-degree relative of CRC was not included in the analysis because of incomplete documentation in the EMR.…”

“…Multivariable analysis of an expanded retrospective cohort study (2012-2015) conducted on the predominantly insured White/EA population served by SBUMC revealed that T2DM was significantly associated with higher ADR ( P = 0.0047) while controlling for multiple other variables[ 15 ]. We now report a retrospective cohort study of index screening colonoscopies performed from 2017-2018 at Kings County Hospital to address the question of whether T2DM is significantly associated with an increased ADR during index screening colonoscopies performed in a predominantly underinsured Black/AA population.…”

“…We now report a retrospective cohort study of index screening colonoscopies performed from 2017-2018 at Kings County Hospital to address the question of whether T2DM is significantly associated with an increased ADR during index screening colonoscopies performed in a predominantly underinsured Black/AA population. To further examine the role of T2DM and race, we conducted a multivariable analysis of this new dataset combined with the recently reported dataset collected on the predominantly insured White/EA population described above[ 15 ].…”