Department of Medicine, Division of Gastroenterology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 722 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
Cancer Epidemiol Biomarkers Prev. 2010 Dec;19(12):3027-36. doi: 10.1158/1055-9965.EPI-10-0486. Epub 2010 Oct 11.
Hyperglycemia may increase the risk of colorectal neoplasia by serving as an energy source for neoplastic growth. We sought to determine whether glycemic control measured by serial hemoglobin A1c (HbA1c) was associated with the risk of colorectal adenoma.
Among a cohort of patients with type 2 diabetes mellitus who received health care within the Kaiser Permanente Northern California from 1994 to 2005, we conducted 2 case-control analyses. Cases had at least 1 colorectal adenoma identified at either colonoscopy (analysis 1) or sigmoidoscopy (analysis 2). Controls had no colorectal neoplasia identified at the corresponding endoscopic examination. Serial HbA1c levels between the cases and the controls were compared using a longitudinal model.
Case-control analysis 1 included 4,248 patients, of whom 1,296 (31%) had at least 1 adenoma. The adjusted mean HbA1c levels among those without any adenomas was 8.20% versus 8.26% among those with at least 1 adenoma, a difference of 0.06% (95% CI = -0.02 to 0.14, P = 0.16). Case-control analysis 2 included 9,813 patients, of whom 951 (10%) had at least 1 distal adenoma. The adjusted mean HbA1c levels among those without any distal adenomas was 8.32% versus 8.37% among those with at least 1 distal adenoma, a difference of 0.05% (95% CI = -00.04 to 0.14, P = 0.25). The results were similar for advanced adenomas.
Glycemic control was not associated with the risk of colorectal adenoma among diabetic persons.
These results would suggest that glycemic control is unlikely to confound the reported association between diabetes medications and the risk of colorectal cancer.
高血糖可能通过为肿瘤生长提供能量而增加结直肠肿瘤的风险。我们试图确定通过连续血红蛋白 A1c（HbA1c）测量的血糖控制是否与结直肠腺瘤的风险相关。
在 1994 年至 2005 年期间接受 Kaiser Permanente 北加利福尼亚医疗保健的 2 型糖尿病患者队列中，我们进行了 2 项病例对照分析。病例在结肠镜检查（分析 1）或乙状结肠镜检查（分析 2）中至少发现 1 个结直肠腺瘤。对照在相应的内镜检查中未发现结直肠肿瘤。使用纵向模型比较病例和对照之间的连续 HbA1c 水平。
病例对照分析 1 纳入 4248 例患者，其中 1296 例（31%）至少有 1 个腺瘤。无任何腺瘤的患者平均 HbA1c 水平为 8.20%，而至少有 1 个腺瘤的患者平均 HbA1c 水平为 8.26%，差异为 0.06%（95%CI=-0.02 至 0.14，P=0.16）。病例对照分析 2 纳入 9813 例患者，其中 951 例（10%）至少有 1 个远端腺瘤。无任何远端腺瘤的患者平均 HbA1c 水平为 8.32%，而至少有 1 个远端腺瘤的患者平均 HbA1c 水平为 8.37%，差异为 0.05%（95%CI=-0.04 至 0.14，P=0.25）。高级别腺瘤的结果相似。
在糖尿病患者中，血糖控制与结直肠腺瘤的风险无关。
这些结果表明，血糖控制不太可能混淆报告的糖尿病药物与结直肠癌风险之间的关联。
