Nagel J M, Göke B
Medizinische Klinik und Poliklinik II, Klinikum Grosshadern, LMU München.
Z Gastroenterol. 2006 Nov;44(11):1153-65. doi: 10.1055/s-2006-927132.
Colorectal carcinoma is one of the most common tumour entities in Western countries. Colorectal carcinoma and type 2 diabetes mellitus share common risk factors. Recent epidemiological studies show an increased risk for colorectal carcinomas in patients with type 2 diabetes mellitus, even more pronounced at therapy with sulfonylureas or insulin. Moreover, a 3-fold risk increase for patients with insulin-dependent type 2 diabetes mellitus in comparison to the general population has been observed. The hyperinsulinaemia hypothesis is based on the premise that elevated plasma levels of insulin and free IGF-1 promote the proliferation of colon cells and lead to a survival benefit of transformed colon carcinoma cells. This is reflected by an altered tumour biology; in patients with type 2 diabetes, tumour progression is more rapid and tumour-associated mortality is increased. Colorectal carcinoma represents an entity that is well amenable to and can potentially be avoided by screening colonoscopy. Recommendations for colorectal carcinoma screening should employ the recent epidemiologic evidence. All patients with type 2 diabetes should be recommended to undergo colonoscopy before starting insulin therapy, and screening intervals should not exceed 5 years. This work provides a review of the evidence, and an algorithm is proposed for a modified screening in patients with type 2 diabetes.
在西方国家，结直肠癌是最常见的肿瘤类型之一。结直肠癌与2型糖尿病有共同的风险因素。近期的流行病学研究表明，2型糖尿病患者患结直肠癌的风险增加，在使用磺脲类药物或胰岛素治疗时更为明显。此外，与普通人群相比，胰岛素依赖型2型糖尿病患者的风险增加了两倍。高胰岛素血症假说基于这样一个前提，即血浆中胰岛素和游离胰岛素样生长因子-1水平升高会促进结肠细胞增殖，并使转化的结肠癌细胞获得生存优势。这反映在肿瘤生物学的改变上；在2型糖尿病患者中，肿瘤进展更快，肿瘤相关死亡率增加。结直肠癌是一种通过结肠镜筛查易于诊断且有可能避免的疾病。结直肠癌筛查建议应采用最新的流行病学证据。所有2型糖尿病患者均应在开始胰岛素治疗前接受结肠镜检查，筛查间隔不应超过5年。本文对相关证据进行了综述，并提出了一种针对2型糖尿病患者的改良筛查算法。
