Ningxia Medical University (Shuangyi Campus), No. 692 Shengli Street, Yinchuan City, Ningxia Hui Autonomous region, China.
Int J Colorectal Dis. 2020 Nov;35(11):2117-2131. doi: 10.1007/s00384-020-03704-w. Epub 2020 Jul 27.
At present, there are many studies on metformin and the risk of colorectal cancer in patients with diabetes, but the conclusions are contradictory. Our aim is to comprehensively collect the published literature and systematically evaluate the relationship between metformin and the risk of colorectal cancer in patients with diabetes.
We systematically searched the MEDLINE, EMBASE, and CENTRAL databases up to March 2020. We adopted adjusted estimates and their 95% confidence intervals (CI) to calculate summary effect estimates using either a fixed-effects or a random-effects model.
A total of 17 articles were included in this study, with a total of 1,092,074 patients with diabetes. Meta-analysis of observational studies showed that metformin treatment could significantly reduce the incidence of colorectal cancer in diabetic patients (adjusted RR = 0.884, 95%CI = 0.829-0.943), and there was heterogeneity between studies (p = 0.013, I = 47.9%). Subgroup analysis showed that metformin treatment was significantly associated with a significantly reduced risk of colorectal cancer in diabetics in America and Europe (adjusted RR = 0.852, 95%CI = 0.786-0.924; adjusted RR = 0.900, 95%CI = 0.845-0.958). Patients with diabetes treated with metformin had a significantly lower risk of colorectal cancer compared with patients who had never been treated with metformin or sulfonamide monotherapy (adjusted RR = 0.863, 95%CI = 0.776-0.960; adjusted RR = 0.911, 95%CI = 0.882-0.941).
Metformin therapy is associated with a significantly reduced risk of colorectal disease in patients with diabetes, and it is necessary to conduct larger, more standardized clinical studies to verify this conclusion.
目前，有许多关于二甲双胍和糖尿病患者结直肠癌风险的研究，但结论相互矛盾。我们的目的是全面收集已发表的文献，并系统评估二甲双胍与糖尿病患者结直肠癌风险之间的关系。
我们系统地检索了 MEDLINE、EMBASE 和 CENTRAL 数据库，截至 2020 年 3 月。我们采用调整后的估计值及其 95%置信区间（CI），使用固定效应或随机效应模型计算汇总效应估计值。
共有 17 项研究纳入本研究，共有 1092074 例糖尿病患者。观察性研究的荟萃分析表明，二甲双胍治疗可显著降低糖尿病患者结直肠癌的发生率（调整后的 RR = 0.884，95%CI = 0.829-0.943），且研究之间存在异质性（p = 0.013，I = 47.9%）。亚组分析表明，二甲双胍治疗与美国和欧洲糖尿病患者结直肠癌风险显著降低相关（调整后的 RR = 0.852，95%CI = 0.786-0.924；调整后的 RR = 0.900，95%CI = 0.845-0.958）。与从未接受过二甲双胍或磺酰脲单药治疗的糖尿病患者相比，接受二甲双胍治疗的糖尿病患者结直肠癌风险显著降低（调整后的 RR = 0.863，95%CI = 0.776-0.960；调整后的 RR = 0.911，95%CI = 0.882-0.941）。
二甲双胍治疗与糖尿病患者结直肠疾病风险显著降低相关，有必要开展更大规模、更标准化的临床研究来验证这一结论。
