Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
Dig Dis Sci. 2024 May;69(5):1834-1843. doi: 10.1007/s10620-024-08350-8. Epub 2024 Mar 22.
BACKGROUND/AIMS: Exogenous insulin therapy increases systemic exposure to insulin which may promote the development of colorectal neoplasia. We sought to evaluate the association between exogenous insulin therapy and the incidence of advanced adenoma in type 2 diabetes mellitus.
A retrospective cohort study was conducted from January 1, 2007, to January 1, 2018, in a regional health system serving the United States Philadelphia metropolitan area, Central New Jersey, and South Central Pennsylvania. Study patients consisted of a random sample of patients with type 2 diabetes mellitus aged 40-80 years who had undergone two rounds of colonoscopy examinations. The exposure was cumulative duration of insulin therapy (i.e., no use, 1-365 days and > 365 days). The outcome was time to incident advanced adenoma.
Of the 975 eligible patients, 184 patients accumulated > 365 days of insulin therapy before the follow-up colonoscopy. The mean (standard deviation) duration between the two rounds of colonoscopy examination was 5.1 (2.9) years among the insulin users and 5.3 (3.9) years among non-users. Compared to no insulin exposure, receiving > 365 days of insulin therapy was associated with an increased incidence of advanced adenoma (adjusted hazard ratio [aHR] 4.84, 95% confidence interval [CI] 2.82-8.30), right-sided advanced adenoma (aHR 5.48, 95% CI 2.90-10.35), and 3 or more adenomas (aHR 2.61, 95% CI 1.46-4.69) at the follow-up colonoscopy examination.
Insulin therapy is associated with an increased risk of advanced adenoma and may serve as a novel risk-stratification factor to enhance the efficiency of existing colorectal cancer screening and surveillance programs.
背景/目的：外源性胰岛素治疗会增加全身胰岛素暴露，从而可能促进结直肠肿瘤的发生。我们旨在评估 2 型糖尿病患者中外源性胰岛素治疗与高级别腺瘤发生的相关性。
本研究为回顾性队列研究，于 2007 年 1 月 1 日至 2018 年 1 月 1 日在美国费城大都市区、新泽西州中部和宾夕法尼亚州中南部的一个区域卫生系统中进行。研究对象为年龄在 40-80 岁之间、接受过两轮结肠镜检查的 2 型糖尿病患者的随机样本。暴露因素为胰岛素治疗的累积时间（即无使用、1-365 天和>365 天）。结局为新发高级别腺瘤的时间。
在 975 名符合条件的患者中，有 184 名患者在随访结肠镜检查前累计接受胰岛素治疗>365 天。在接受胰岛素治疗的患者中，两轮结肠镜检查之间的平均（标准差）时间为 5.1（2.9）年，而非使用者为 5.3（3.9）年。与无胰岛素暴露相比，接受>365 天胰岛素治疗与高级别腺瘤（调整后的危险比[aHR] 4.84，95%置信区间[CI] 2.82-8.30）、右侧高级别腺瘤（aHR 5.48，95% CI 2.90-10.35）和 3 个或更多腺瘤（aHR 2.61，95% CI 1.46-4.69）的发生率增加相关。
胰岛素治疗与高级别腺瘤的风险增加相关，可能成为增强现有结直肠癌筛查和监测计划效率的新型风险分层因素。
