Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
BMJ Open Gastroenterol. 2021 Dec;8(1). doi: 10.1136/bmjgast-2021-000786.
Prevalent type 2 diabetes (T2D) is associated with an increased risk of colorectal cancer and could impair the quality of bowel preparation for colonoscopy. This may in turn increase the risk of overlooked precancerous polyps and subsequent risk of post-colonoscopy colorectal cancer (PCCRC). We investigated whether patients with T2D are at increased risk of PCCRC compared with patients without T2D.
We conducted a population-based cohort study of patients with T2D and without T2D undergoing colonoscopy in Denmark (1995-2015). We investigated the risk of PCCRC by calculating >6 to 36 months cumulative incidence proportions (CIPs) treating death and colectomy as competing risks. Using Cox proportional-hazards regression analyses, we also computed HRs of PCCRC, comparing patients with T2D and non-T2D. According to the World Endoscopy Organization guidelines, we calculated PCCRC 3-year rates to estimate the proportions of T2D and non-T2D CRC patients experiencing PCCRC.
We identified 29 031 patients with T2D and 333 232 patients without T2D undergoing colonoscopy. We observed 250 PCCRCs among patients with T2D and 1658 PCCRCs among patients without T2D. The >6 to 36 months CIP after a first-time colonoscopy was 0.64% (95% CI 0.55% to 0.74%) for T2D and 0.36% (95% CI 0.34% to 0.38%) for patients without T2D. The HRs of PCCRC were 1.43 (95% CI 1.21 to 1.72) after a first-time colonoscopy and 1.18 (95% CI 0.75 to 1.85) after a second-time colonoscopy. The PCCRC 3-year rate was 7.9% for patients with T2D and 7.4% for patients without T2D.
T2D may be associated with an increased HR of PCCRC.
普遍存在的 2 型糖尿病（T2D）与结直肠癌风险增加相关，并且可能会影响结肠镜检查的肠道准备质量。这反过来可能会增加被忽视的癌前息肉的风险，进而增加结直肠镜检查后结直肠癌（PCCRC）的风险。我们调查了 T2D 患者与无 T2D 患者相比，是否存在 PCCRC 风险增加的情况。
我们在丹麦进行了一项基于人群的 T2D 患者和无 T2D 患者的结肠镜检查队列研究（1995-2015 年）。我们通过计算 >6 至 36 个月累积发病率比例（CIP）来评估 PCCRC 的风险，将死亡和结肠切除术视为竞争风险。我们还使用 Cox 比例风险回归分析计算了 T2D 和非 T2D 患者 PCCRC 的 HR。根据世界内镜组织指南，我们计算了 PCCRC 3 年发生率，以估计 T2D 和非 T2D CRC 患者中发生 PCCRC 的比例。
我们共确定了 29031 例 T2D 患者和 333232 例无 T2D 患者进行了结肠镜检查。我们在 T2D 患者中观察到 250 例 PCCRC，在无 T2D 患者中观察到 1658 例 PCCRC。首次结肠镜检查后 >6 至 36 个月的 CIP 为 T2D 患者 0.64%（95%CI 0.55%至 0.74%），无 T2D 患者为 0.36%（95%CI 0.34%至 0.38%）。首次结肠镜检查后 PCCRC 的 HR 为 1.43（95%CI 1.21 至 1.72），第二次结肠镜检查后为 1.18（95%CI 0.75 至 1.85）。T2D 患者的 PCCRC 3 年发生率为 7.9%，无 T2D 患者为 7.4%。
T2D 可能与 PCCRC 的 HR 增加相关。
