Relationship between Diabetes Mellitus and Risk of Colorectal Cancer: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SHAO Qi ,  REN Ying , ZHAO Cuichun , WANG Hongping

Department of Internal Medical Ward, Shanghai Clinical Center for Diabetes, The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China;

Corresponding author：

REN Ying, Email: renying@sjtu.edu.cn

Keywords：

Diabetes mellitus; Colorectal cancer; Cohort study; Meta-analysis

DOI：

10.7507/1672-2531.20110093

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically review the correlation between diabetes and the incidence rate of colorectal cancer, so as to provide objective proof for early screening diabetic patients with colorectal cancer.
Methods 　The databases such as MEDLINE and EMbase published from January 1990 to July 2010 were searched to include cohort studies. The meta-analysis including seventeen qualified studies was performed by using the Cochrane Collaboration’s RevMan 4.3 software.
Results 　The results of meta-analyses of 17 cohort studies involving 1 690 869 participants indicated that the diabetes patients had a higher incidence rate of colorectal cancer compared with the control group (16.50‰ vs. 10.13‰). The odds ratio (OR) was 1.43, and the 95% confidence interval (CI) was from 1.29 to 1.60. The results were consistent by sex compared with the control group, although the OR for colorectal cancer in diabetes was little higher in males than females (1.47 vs. 1.41).
Conclusion 　Diabetes mellitus is a risk factor of inducing colorectal cancer.

Citation： SHAO Qi,REN Ying,ZHAO Cuichun,WANG Hongping. Relationship between Diabetes Mellitus and Risk of Colorectal Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(5): 518-523. doi: 10.7507/1672-2531.20110093 Copy

1.	1 Hjartåker A, Langseth H, Weiderpass E. Obesity and diabetes epidemics: cancer repercussions. Adv Exp Med Biol , 2008, 630: 72-93.
2.	2 Chung YC, Chaen YL, Hsu CP. Clinical significance of tissue expression of interleukin-6 in colorectal carcinoma. Anticancer Res , 2006, 26(5B): 3905-3911.
3.	3 Pellegrini M, Marzocca G. Obesity, insulin-like growth factors and colorectal cancer. Panminerva Med , 2006, 48(2): 143-144.
4.	4 Wells GA, Shea B, O’Connell D, et al . The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. The Ottawa Health Research Institute, 2010.
5.	5 Steenland K, Nowlin S, Palu S. Cancer incidence in the National Health and Nutrition Survey I. Follow-up data: diabetes, cholesterol, pulse and physical activity. Cancer Epidemiol Biomarkers Prev , 1995, 4(8): 807-811.
6.	6 Will JC, Galuska DA, Vinicor F, et al . Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol , 1998, 147(9): 816-825.
7.	7 Hu FB, Manson JE, Liu S, et al . Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst , 1999, 91(6): 542-547.
8.	8 Schoen RE, Tangen CM, Kuller LH, et al . Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst , 1999, 91(13): 1147-1154.
9.	9 Nilsen TI, Vatten LJ. Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer , 2001, 84(3): 417-422.
10.	10 Sandhu MS, Luben R, Khaw KT. Self reported non-insulin dependent diabetes, family history, and risk of prevalent colorectal cancer: population based, cross sectional study. J Epidemiol Community Health , 2001, 55(11): 804-805.
11.	11 Khaw KT, Wareham N, Bingham S, et al . Preliminary communication: glycated hemoglobin, diabetes, and incident colorectal cancer in men and women: a prospective analysis from the European prospective investigation into cancer-Norfolk study. Cancer Epidemiol Biomarkers Prev , 2004, 13(6): 915-919.
12.	12 Limburg PJ, Anderson KE, Johnson TW, et al . Diabetes mellitus and subsite-specific colorectal cancer risks in the Iowa Women's Health Study. Cancer Epidemiol Biomarkers Prev , 2005, 14(1): 133-137.
13.	13 Larsson SC, Giovannucci E, Wolk A. Diabetes and colorectal cancer incidence in the cohort of Swedish men. Diabetes Care , 2005, 28(7): 1805-1807.
14.	14 Seow A, Yuan JM, Koh WP, et al . Diabetes mellitus and risk of colorectal cancer in the Singapore Chinese Health Study. J Natl Cancer Inst , 2006, 98(2): 135-138.
15.	15 Inoue M, Iwasaki M, Otani T, et al . Diabetes mellitus and the risk of cancer: results from a large-scale population-based cohort study in Japan. Arch Intern Med , 2006, 166(17): 1871-1877.
16.	16 Ahmed RL, Schmitz KH, Anderson KE, et al . The metabolic syndrome and risk of incident colorectal cancer. Cancer , 2006, 107(1): 28-36.
17.	17 Bowers K, Albanes D, Limburg P, et al . A prospective study of anthropometric and clinical measurements associated with insulin resistance syndrome and colorectal cancer in male smokers. Am J Epidemiol , 2006, 164(7): 652-664.
18.	18 Stürmer T, Buring JE, Lee IM, et al . Metabolic abnormalities and risk for colorectal cancer in the physicians' health study. Cancer Epidemiol Biomarkers Prev , 2006, 15(12): 2391-2397.
19.	19 Ogunleye AA, Ogston SA, Morris AD, et al . A cohort study of the risk of cancer associated with type 2 diabetes. Br J Cancer , 2009, 101(7): 1199-1201.
20.	20 Flood A, Strayer L, Schairer C, et al . Diabetes and risk of incident colorectal cancer in a prospective cohort of women. Cancer Causes Control , 2010, 21(8): 1277-1284.
21.	21 He J, Stram DO, Kolonel LN, et al . The association of diabetes with colorectal cancer risk: the Multiethnic Cohort. Br J Cancer , 2010, 103(1): 120-126.
22.	22 Huang XF, Chen JZ. Obesity, the PI3K/Akt signal pathway and colon cancer. Obes Rev , 2009, 10(6): 610-616.
23.	23 Jin T. Why diabetes patients are more prone to the development of colon cancer? Med Hypotheses , 2008, 71(2): 241-244.
24.	24 Pais R, Silaghi H, Silaghi AC, et al . Metabolic syndrome and risk of subsequent colorectal cancer. World J Gastroenterol , 2009, 15(41): 5141-5148.
25.	25 Siddiqui AA. Metabolic syndrome and its association with colorectal cancer: a review. Am J Med Sci , 2011, 341(3):227-231.
26.	26 Pelucchi C, Negri E, Talamini R, et al . Metabolic syndrome is associated with colorectal cancer in men. Eur J Cancer , 2010, 46(10): 1866-1872.
27.	27 Schiel R, Müller UA, Braun A, et al . Risk of malignancies in patients with insulin-treated diabetes mellitus: results of a population-based trial with 10-year follow-up (JEVIN). Eur J Med Res , 2005, 10(8): 339-344.
28.	28 Nicolucci A. Epidemiological aspects of neoplasms in diabetes. Acta Diabetol , 2010, 47(2): 87-95.
29.	29 Wang D, Dubois RN. The role of COX-2 in intestinal inflammation and colorectal cancer. Oncogene , 2010, 29(6): 781-788.
30.	30 Malicki S, Winiarski M, Matlok M, et al . IL-6 and IL-8 responses of colorectal cancer in vivo and in vitro cancer cells subjected to simvastatin. J Physiol Pharmacol , 2009, 60(4): 141-146.
31.	31 Lee MS, Hsu CC, Wahlqvist ML, et al . Type 2 diabetes increases and metformin reduces total, colorectal, liver and pancreatic cancer incidences in Taiwanese: a representative population prospective cohort study of 800,000 individuals. BMC Cancer , 2011, 11: 20.
32.	32 Zhao G, Ford ES, Ahluwalia IB, et al . Prevalence and trends of receipt of cancer screenings among US women with diagnosed diabetes. J Gen Intern Med , 2009, 24(2): 270-275.
33.	33 Giouleme O, Diamantidis MD, Katsaros MG. Is diabetes a causal agent for colorectal cancer? Pathophysiological and molecular mechanisms. World J Gastroenterol , 2011, 17(4): 444-448.
34.	34 Campbell PT, Deka A, Jacobs EJ, et al . Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men. Gastroenterology , 2010, 139(4): 1138-1146.
35.	35 Rensing KL, Houttuijn Bloemendaal FM, Weijers EM, et al . Could recombinant insulin compounds contribute to adenocarcinoma progression by stimulating local angiogenesis? Diabetologia , 2010, 53(5): 966-970.

1. 1 Hjartåker A, Langseth H, Weiderpass E. Obesity and diabetes epidemics: cancer repercussions. Adv Exp Med Biol , 2008, 630: 72-93.
2. 2 Chung YC, Chaen YL, Hsu CP. Clinical significance of tissue expression of interleukin-6 in colorectal carcinoma. Anticancer Res , 2006, 26(5B): 3905-3911.
3. 3 Pellegrini M, Marzocca G. Obesity, insulin-like growth factors and colorectal cancer. Panminerva Med , 2006, 48(2): 143-144.
4. 4 Wells GA, Shea B, O’Connell D, et al . The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. The Ottawa Health Research Institute, 2010.
5. 5 Steenland K, Nowlin S, Palu S. Cancer incidence in the National Health and Nutrition Survey I. Follow-up data: diabetes, cholesterol, pulse and physical activity. Cancer Epidemiol Biomarkers Prev , 1995, 4(8): 807-811.
6. 6 Will JC, Galuska DA, Vinicor F, et al . Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol , 1998, 147(9): 816-825.
7. 7 Hu FB, Manson JE, Liu S, et al . Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst , 1999, 91(6): 542-547.
8. 8 Schoen RE, Tangen CM, Kuller LH, et al . Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst , 1999, 91(13): 1147-1154.
9. 9 Nilsen TI, Vatten LJ. Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer , 2001, 84(3): 417-422.
10. 10 Sandhu MS, Luben R, Khaw KT. Self reported non-insulin dependent diabetes, family history, and risk of prevalent colorectal cancer: population based, cross sectional study. J Epidemiol Community Health , 2001, 55(11): 804-805.
11. 11 Khaw KT, Wareham N, Bingham S, et al . Preliminary communication: glycated hemoglobin, diabetes, and incident colorectal cancer in men and women: a prospective analysis from the European prospective investigation into cancer-Norfolk study. Cancer Epidemiol Biomarkers Prev , 2004, 13(6): 915-919.
12. 12 Limburg PJ, Anderson KE, Johnson TW, et al . Diabetes mellitus and subsite-specific colorectal cancer risks in the Iowa Women's Health Study. Cancer Epidemiol Biomarkers Prev , 2005, 14(1): 133-137.
13. 13 Larsson SC, Giovannucci E, Wolk A. Diabetes and colorectal cancer incidence in the cohort of Swedish men. Diabetes Care , 2005, 28(7): 1805-1807.
14. 14 Seow A, Yuan JM, Koh WP, et al . Diabetes mellitus and risk of colorectal cancer in the Singapore Chinese Health Study. J Natl Cancer Inst , 2006, 98(2): 135-138.
15. 15 Inoue M, Iwasaki M, Otani T, et al . Diabetes mellitus and the risk of cancer: results from a large-scale population-based cohort study in Japan. Arch Intern Med , 2006, 166(17): 1871-1877.
16. 16 Ahmed RL, Schmitz KH, Anderson KE, et al . The metabolic syndrome and risk of incident colorectal cancer. Cancer , 2006, 107(1): 28-36.
17. 17 Bowers K, Albanes D, Limburg P, et al . A prospective study of anthropometric and clinical measurements associated with insulin resistance syndrome and colorectal cancer in male smokers. Am J Epidemiol , 2006, 164(7): 652-664.
18. 18 Stürmer T, Buring JE, Lee IM, et al . Metabolic abnormalities and risk for colorectal cancer in the physicians' health study. Cancer Epidemiol Biomarkers Prev , 2006, 15(12): 2391-2397.
19. 19 Ogunleye AA, Ogston SA, Morris AD, et al . A cohort study of the risk of cancer associated with type 2 diabetes. Br J Cancer , 2009, 101(7): 1199-1201.
20. 20 Flood A, Strayer L, Schairer C, et al . Diabetes and risk of incident colorectal cancer in a prospective cohort of women. Cancer Causes Control , 2010, 21(8): 1277-1284.
21. 21 He J, Stram DO, Kolonel LN, et al . The association of diabetes with colorectal cancer risk: the Multiethnic Cohort. Br J Cancer , 2010, 103(1): 120-126.
22. 22 Huang XF, Chen JZ. Obesity, the PI3K/Akt signal pathway and colon cancer. Obes Rev , 2009, 10(6): 610-616.
23. 23 Jin T. Why diabetes patients are more prone to the development of colon cancer? Med Hypotheses , 2008, 71(2): 241-244.
24. 24 Pais R, Silaghi H, Silaghi AC, et al . Metabolic syndrome and risk of subsequent colorectal cancer. World J Gastroenterol , 2009, 15(41): 5141-5148.
25. 25 Siddiqui AA. Metabolic syndrome and its association with colorectal cancer: a review. Am J Med Sci , 2011, 341(3):227-231.
26. 26 Pelucchi C, Negri E, Talamini R, et al . Metabolic syndrome is associated with colorectal cancer in men. Eur J Cancer , 2010, 46(10): 1866-1872.
27. 27 Schiel R, Müller UA, Braun A, et al . Risk of malignancies in patients with insulin-treated diabetes mellitus: results of a population-based trial with 10-year follow-up (JEVIN). Eur J Med Res , 2005, 10(8): 339-344.
28. 28 Nicolucci A. Epidemiological aspects of neoplasms in diabetes. Acta Diabetol , 2010, 47(2): 87-95.
29. 29 Wang D, Dubois RN. The role of COX-2 in intestinal inflammation and colorectal cancer. Oncogene , 2010, 29(6): 781-788.
30. 30 Malicki S, Winiarski M, Matlok M, et al . IL-6 and IL-8 responses of colorectal cancer in vivo and in vitro cancer cells subjected to simvastatin. J Physiol Pharmacol , 2009, 60(4): 141-146.
31. 31 Lee MS, Hsu CC, Wahlqvist ML, et al . Type 2 diabetes increases and metformin reduces total, colorectal, liver and pancreatic cancer incidences in Taiwanese: a representative population prospective cohort study of 800,000 individuals. BMC Cancer , 2011, 11: 20.
32. 32 Zhao G, Ford ES, Ahluwalia IB, et al . Prevalence and trends of receipt of cancer screenings among US women with diagnosed diabetes. J Gen Intern Med , 2009, 24(2): 270-275.
33. 33 Giouleme O, Diamantidis MD, Katsaros MG. Is diabetes a causal agent for colorectal cancer? Pathophysiological and molecular mechanisms. World J Gastroenterol , 2011, 17(4): 444-448.
34. 34 Campbell PT, Deka A, Jacobs EJ, et al . Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men. Gastroenterology , 2010, 139(4): 1138-1146.
35. 35 Rensing KL, Houttuijn Bloemendaal FM, Weijers EM, et al . Could recombinant insulin compounds contribute to adenocarcinoma progression by stimulating local angiogenesis? Diabetologia , 2010, 53(5): 966-970.

Chinese Journal of Evidence-Based Medicine

Relationship between Diabetes Mellitus and Risk of Colorectal Cancer: A Meta-analysis

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