Exogenous Insulin Therapy Is Associated with the Risk of Advanced Colorectal Adenoma in Patients with Diabetes Mellitus.
Exogenous Insulin Therapy Is Associated with the Risk of Advanced Colorectal Adenoma in Patients with Diabetes Mellitus.
复制标题
外源性胰岛素治疗与糖尿病患者晚期结直肠腺瘤的风险相关。
DOI：
10.1007/s10620-024-08350-8
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发表时间：
2024
影响因子：
3.1
通讯作者：
Yang,Yu-Xiao
中科院分区：
文献类型：
--
作者：
Lam,Robert;Hwang,Wei-Ting;Chennareddy,Sumanth;Boursi,Ben;Yang,Yu-Xiao
背景/目的外源性胰岛素治疗增加全身胰岛素暴露，可能促进结直肠肿瘤的发展。我们试图评估外源性胰岛素治疗与2型糖尿病晚期腺瘤发病率之间的相关性。MethodsA回顾性队列研究于2007年1月1日至2018年1月1日在美国费城大都会区、新泽西中部和宾夕法尼亚州中南部的一个区域卫生系统进行。研究患者包括随机抽样的年龄在40-80岁之间的2型糖尿病患者，他们接受了两轮结肠镜检查。不使用，1-365天和> 365天）。结果是时间事件先进adenocarcino.ResultsOf 975合格的患者，184例患者累积> 365天的胰岛素治疗前的后续结肠镜检查。两轮结肠镜检查之间的平均（标准差）持续时间在胰岛素使用者中为5.1（2.9）年，在非使用者中为5.3（3.9）年。与无胰岛素暴露相比，接受> 365天胰岛素治疗与晚期腺瘤发生率增加相关（校正风险比[aHR] 4.84，95%置信区间[CI] 2.82-8.30），右侧晚期腺瘤（aHR 5.48，95% CI 2.90-10.35）和3个或更多腺瘤（aHR 2.61，结论胰岛素治疗与晚期腺瘤的风险增加相关，并可能作为一种新的风险，分层因素，以提高现有的结直肠癌筛查和监测计划的效率。
Background/AimsExogenous 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.MethodsA 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.ResultsOf 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.ConclusionInsulin 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.Graphical Abstract