Budzynska Katarzyna, Passerman Daniel, White-Perkins Denise, Rees Della A, Xu Jinping, Lamerato Lois, Schooley Susan
Department of Family Medicine, Henry Ford Hospital, Detroit, MI, USA.
Department of Family Medicine, Henry Ford Health System, 3370 E Jefferson, Detroit, MI, 48207, USA.
BMC Fam Pract. 2018 Aug 29;19(1):145. doi: 10.1186/s12875-018-0835-1.
Colorectal cancer (CRC) develops from colorectal adenomatous polyps. This study is to determine if diabetes mellitus (DM), its treatment, and hemoglobin A1c (HbA1c) level are associated with increased risk of colorectal adenomatous polyps.
This was a retrospective cohort study that included patients who had at least one colonoscopy and were continuously enrolled in a single managed care organization during a 10-year period (2002-2012). Of these patients (N = 11,933), 1800 were randomly selected for chart review to examine the details of colonoscopy and pathology findings and to confirm the diagnosis of DM. Multivariable logistic regression analyses were performed to assess the associations between DM, its treatment, HbA1c level and adenomatous polyps (our main outcome).
Among the total of 11,933 patients with a mean (standard deviation) age of 56 (± 8.8) years, 2306 (19.3%) had DM and 75 (0.6%) had CRC. Among the 1800 under chart review, 445 (24.7%) had DM, 11 (0.6%) had CRC and 537 (29.8%) had adenomatous polyps. In bivariate analysis, patients with DM had 1.45 odds of developing adenomatous polyps compared to those without DM. This effect was attenuated (odds ratio = 1.25, 95% CI: 0.96-1.62, p = 0.09) after adjusting for confounders such as age, gender, race/ethnicity, and body mass index. There was no significant association between type or duration of DM treatment or HbA1c level and adenomatous polyps.
Our study confirmed the known increased risk of adenomatous polyps with advancing age, male gender, Hispanic race/ethnicity and higher body mass index. Although it suggested an association between DM and adenomatous polyps, a statistically significant association was not observed after controlling for other potential confounders. Further studies with a larger sample size are needed to further elucidate this relationship.
结直肠癌（CRC）由结直肠腺瘤性息肉发展而来。本研究旨在确定糖尿病（DM）及其治疗方法和糖化血红蛋白（HbA1c）水平是否与结直肠腺瘤性息肉风险增加相关。
这是一项回顾性队列研究，纳入了在10年期间（2002 - 2012年）至少接受过一次结肠镜检查且持续登记在单一管理式医疗组织中的患者。在这些患者（N = 11,933）中，随机选择1800例进行病历审查，以检查结肠镜检查和病理结果的详细情况，并确认DM诊断。进行多变量逻辑回归分析，以评估DM及其治疗方法、HbA1c水平与腺瘤性息肉（我们的主要结局）之间的关联。
在总共11,933例平均（标准差）年龄为56（±8.8）岁的患者中，2306例（19.3%）患有DM，75例（0.6%）患有CRC。在接受病历审查的1800例患者中，445例（24.7%）患有DM，11例（0.6%）患有CRC，537例（29.8%）患有腺瘤性息肉。在双变量分析中，与未患DM的患者相比，患DM的患者发生腺瘤性息肉的几率为1.45。在调整年龄、性别、种族/民族和体重指数等混杂因素后，这种效应减弱（比值比 = 1.25，95%可信区间：0.96 - 1.62，p = 0.09）。DM治疗类型或持续时间以及HbA1c水平与腺瘤性息肉之间无显著关联。
我们的研究证实了随着年龄增长、男性、西班牙裔种族/民族以及较高体重指数，腺瘤性息肉风险增加这一已知情况。虽然研究提示DM与腺瘤性息肉之间存在关联，但在控制其他潜在混杂因素后未观察到统计学上的显著关联。需要进行更大样本量的进一步研究以进一步阐明这种关系。
