Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
Gut. 2024 Jul 11;73(8):1313-1320. doi: 10.1136/gutjnl-2023-331701.
Whether varying degrees of glycaemic control impact colonic neoplasm risk in patients with diabetes mellitus (DM) remains uncertain.
Patients with newly diagnosed DM were retrieved from 2005 to 2013. Optimal glycaemic control at baseline was defined as mean haemoglobin A1c (HbA1c)<7%. Outcomes of interest included colorectal cancer (CRC) and colonic adenoma development. We used propensity score (PS) matching with competing risk models to estimate subdistribution HRs (SHRs). We further analysed the combined effect of baseline and postbaseline glycaemic control based on time-weighted mean HbA1c during follow-up.
Of 88 468 PS-matched patients with DM (mean (SD) age: 61.5 (±11.7) years; male: 47 127 (53.3%)), 1229 (1.4%) patients developed CRC during a median follow-up of 7.2 (IQR: 5.5-9.4) years. Optimal glycaemic control was associated with lower CRC risk (SHR 0.72; 95% CI 0.65 to 0.81). The beneficial effect was limited to left-sided colon (SHR 0.71; 95% CI 0.59 to 0.85) and rectum (SHR 0.71; 95% CI 0.57 to 0.89), but not right-sided colon (SHR 0.86; 95% CI 0.67 to 1.10). Setting suboptimal glycaemic control at baseline/postbaseline as a reference, a decreased CRC risk was found in optimal control at postbaseline (SHR 0.79), baseline (SHR 0.71) and both time periods (SHR 0.61). Similar associations were demonstrated using glycaemic control as a time-varying covariate (HR 0.75). A stepwise greater risk of CRC was found (P<0.001) with increasing HbA1c (SHRs 1.34, 1.30, 1.44, 1.58 for HbA1c 7.0% to <7.5%, 7.5% to <8.0%, 8.0% to <8.5% and ≥8.5%, respectively). Optimal glycaemic control was associated with a lower risk of any, non-advanced and advanced colonic adenoma (SHRs 0.73-0.87).
Glycaemic control in patients with DM was independently associated with the risk of colonic adenoma and CRC development with a biological gradient.
糖尿病（DM）患者血糖控制程度不同是否会影响结直肠肿瘤的风险尚不确定。
从 2005 年至 2013 年期间检索出新诊断为 DM 的患者。将基线时的最佳血糖控制定义为平均血红蛋白 A1c（HbA1c）<7%。感兴趣的结局包括结直肠癌（CRC）和结肠腺瘤的发生。我们使用倾向评分（PS）匹配和竞争风险模型来估计亚分布风险比（SHR）。我们进一步根据随访期间的时间加权平均 HbA1c 分析了基线和基线后血糖控制的综合效果。
在 88468 名经 PS 匹配的 DM 患者（平均（SD）年龄：61.5（±11.7）岁；男性：47127（53.3%））中，1229 名患者在中位随访 7.2（IQR：5.5-9.4）年后发生 CRC。最佳血糖控制与较低的 CRC 风险相关（SHR 0.72；95%CI 0.65-0.81）。这种有益作用仅限于左半结肠（SHR 0.71；95%CI 0.59-0.85）和直肠（SHR 0.71；95%CI 0.57-0.89），但右侧结肠（SHR 0.86；95%CI 0.67-1.10）则不然。将基线和基线后血糖控制不佳设定为参考，发现基线后（SHR 0.79）、基线时（SHR 0.71）和两个时间段（SHR 0.61）的最佳血糖控制可降低 CRC 风险。使用血糖控制作为时间变化的协变量也得到了类似的关联（HR 0.75）。随着 HbA1c 的升高（SHRs 1.34、1.30、1.44、1.58 分别为 HbA1c 7.0%至<7.5%、7.5%至<8.0%、8.0%至<8.5%和≥8.5%），发现 CRC 的风险逐渐增加（P<0.001）。最佳血糖控制与任何、非晚期和晚期结肠腺瘤的风险降低相关（SHR 0.73-0.87）。
DM 患者的血糖控制与结直肠腺瘤和 CRC 发展风险呈独立相关，存在生物学梯度。
