Type 2 diabetes, antidiabetic medications, and colorectal cancer risk: Two case-control studies from Italy and Spain

Valentina Rosato, Alessandra Tavani, Esther Gràcia-Lavedan, Elisabeth Guino, Gemma Castaño-Vinyals, Cristina M. Villanueva, Manolis Kogevinas, Jerry Polesel, Diego Serraino, Federica Edith Pisa, Fabio Barbone, Victor Moreno, Carlo La Vecchia, Cristina Bosetti

Research output: Contribution to journalArticle

Abstract

Background: Type 2 diabetes mellitus has been associated with an excess risk of colorectal cancer, although the time-risk relationship is unclear, and there is limited information on the role of antidiabetic medications. Aim: We examined the association between type 2 diabetes, antidiabetic medications, and the risk of colorectal cancer, considering also duration of exposures. Methods: We analyzed data derived from two companion case-control studies conducted in Italy and Spain between 2007 and 2013 on 1,147 histologically confirmed colorectal cancer cases and 1,594 corresponding controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by unconditional multiple logistic regression models, adjusted for socioeconomic factors and major potential confounding factors. Results: Overall, 14% of cases and 12% of controls reported a diagnosis of diabetes, corresponding to an OR of colorectal cancer of 1.21 (95% CI 0.95-1.55). The OR was 1.49 (95% CI 0.97-2.29) for a duration of diabetes of at least 15 years. The OR was 1.53 (95% CI 1.06-2.19) for proximal colon cancer, 0.94 (95% CI 0.66-1.36) for distal colon cancer, and 1.32 (95% CI 0.94-1.87) for rectal cancer. In comparison with no use, metformin use was associated with a decreased colorectal cancer risk (OR 0.47, 95% CI 0.24-0.92), while insulin use was associated with an increased risk (OR 2.20, 95% CI 1.12-4.33); these associations were stronger for longer use (OR 0.36 and 8.18 for ≥10 years of use of metformin and insulin, respectively). Conclusion: This study shows evidence of a positive association between diabetes and colorectal cancer, mainly proximal colon cancer. Moreover, it indicates a negative association between colorectal cancer and metformin use and a positive association for insulin use.

Original languageEnglish
Article number210
JournalFrontiers in Oncology
Volume6
Issue numberOCT
DOIs
Publication statusPublished - Oct 6 2016

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Hypoglycemic Agents
Spain
Type 2 Diabetes Mellitus
Italy
Case-Control Studies
Colorectal Neoplasms
Odds Ratio
Confidence Intervals
Metformin
Colonic Neoplasms
Insulin
Logistic Models
Rectal Neoplasms

Keywords

  • Antidiabetic medications
  • Colorectal cancer
  • Diabetes
  • Insulin
  • Metformin
  • Risk factor

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Type 2 diabetes, antidiabetic medications, and colorectal cancer risk : Two case-control studies from Italy and Spain. / Rosato, Valentina; Tavani, Alessandra; Gràcia-Lavedan, Esther; Guino, Elisabeth; Castaño-Vinyals, Gemma; Villanueva, Cristina M.; Kogevinas, Manolis; Polesel, Jerry; Serraino, Diego; Pisa, Federica Edith; Barbone, Fabio; Moreno, Victor; La Vecchia, Carlo; Bosetti, Cristina.

In: Frontiers in Oncology, Vol. 6, No. OCT, 210, 06.10.2016.

Research output: Contribution to journalArticle

Rosato, V, Tavani, A, Gràcia-Lavedan, E, Guino, E, Castaño-Vinyals, G, Villanueva, CM, Kogevinas, M, Polesel, J, Serraino, D, Pisa, FE, Barbone, F, Moreno, V, La Vecchia, C & Bosetti, C 2016, 'Type 2 diabetes, antidiabetic medications, and colorectal cancer risk: Two case-control studies from Italy and Spain', Frontiers in Oncology, vol. 6, no. OCT, 210. https://doi.org/10.3389/fonc.2016.00210
Rosato, Valentina ; Tavani, Alessandra ; Gràcia-Lavedan, Esther ; Guino, Elisabeth ; Castaño-Vinyals, Gemma ; Villanueva, Cristina M. ; Kogevinas, Manolis ; Polesel, Jerry ; Serraino, Diego ; Pisa, Federica Edith ; Barbone, Fabio ; Moreno, Victor ; La Vecchia, Carlo ; Bosetti, Cristina. / Type 2 diabetes, antidiabetic medications, and colorectal cancer risk : Two case-control studies from Italy and Spain. In: Frontiers in Oncology. 2016 ; Vol. 6, No. OCT.
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abstract = "Background: Type 2 diabetes mellitus has been associated with an excess risk of colorectal cancer, although the time-risk relationship is unclear, and there is limited information on the role of antidiabetic medications. Aim: We examined the association between type 2 diabetes, antidiabetic medications, and the risk of colorectal cancer, considering also duration of exposures. Methods: We analyzed data derived from two companion case-control studies conducted in Italy and Spain between 2007 and 2013 on 1,147 histologically confirmed colorectal cancer cases and 1,594 corresponding controls. Odds ratios (ORs) and 95{\%} confidence intervals (CIs) were estimated by unconditional multiple logistic regression models, adjusted for socioeconomic factors and major potential confounding factors. Results: Overall, 14{\%} of cases and 12{\%} of controls reported a diagnosis of diabetes, corresponding to an OR of colorectal cancer of 1.21 (95{\%} CI 0.95-1.55). The OR was 1.49 (95{\%} CI 0.97-2.29) for a duration of diabetes of at least 15 years. The OR was 1.53 (95{\%} CI 1.06-2.19) for proximal colon cancer, 0.94 (95{\%} CI 0.66-1.36) for distal colon cancer, and 1.32 (95{\%} CI 0.94-1.87) for rectal cancer. In comparison with no use, metformin use was associated with a decreased colorectal cancer risk (OR 0.47, 95{\%} CI 0.24-0.92), while insulin use was associated with an increased risk (OR 2.20, 95{\%} CI 1.12-4.33); these associations were stronger for longer use (OR 0.36 and 8.18 for ≥10 years of use of metformin and insulin, respectively). Conclusion: This study shows evidence of a positive association between diabetes and colorectal cancer, mainly proximal colon cancer. Moreover, it indicates a negative association between colorectal cancer and metformin use and a positive association for insulin use.",
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T2 - Two case-control studies from Italy and Spain

AU - Rosato, Valentina

AU - Tavani, Alessandra

AU - Gràcia-Lavedan, Esther

AU - Guino, Elisabeth

AU - Castaño-Vinyals, Gemma

AU - Villanueva, Cristina M.

AU - Kogevinas, Manolis

AU - Polesel, Jerry

AU - Serraino, Diego

AU - Pisa, Federica Edith

AU - Barbone, Fabio

AU - Moreno, Victor

AU - La Vecchia, Carlo

AU - Bosetti, Cristina

PY - 2016/10/6

Y1 - 2016/10/6

N2 - Background: Type 2 diabetes mellitus has been associated with an excess risk of colorectal cancer, although the time-risk relationship is unclear, and there is limited information on the role of antidiabetic medications. Aim: We examined the association between type 2 diabetes, antidiabetic medications, and the risk of colorectal cancer, considering also duration of exposures. Methods: We analyzed data derived from two companion case-control studies conducted in Italy and Spain between 2007 and 2013 on 1,147 histologically confirmed colorectal cancer cases and 1,594 corresponding controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by unconditional multiple logistic regression models, adjusted for socioeconomic factors and major potential confounding factors. Results: Overall, 14% of cases and 12% of controls reported a diagnosis of diabetes, corresponding to an OR of colorectal cancer of 1.21 (95% CI 0.95-1.55). The OR was 1.49 (95% CI 0.97-2.29) for a duration of diabetes of at least 15 years. The OR was 1.53 (95% CI 1.06-2.19) for proximal colon cancer, 0.94 (95% CI 0.66-1.36) for distal colon cancer, and 1.32 (95% CI 0.94-1.87) for rectal cancer. In comparison with no use, metformin use was associated with a decreased colorectal cancer risk (OR 0.47, 95% CI 0.24-0.92), while insulin use was associated with an increased risk (OR 2.20, 95% CI 1.12-4.33); these associations were stronger for longer use (OR 0.36 and 8.18 for ≥10 years of use of metformin and insulin, respectively). Conclusion: This study shows evidence of a positive association between diabetes and colorectal cancer, mainly proximal colon cancer. Moreover, it indicates a negative association between colorectal cancer and metformin use and a positive association for insulin use.

AB - Background: Type 2 diabetes mellitus has been associated with an excess risk of colorectal cancer, although the time-risk relationship is unclear, and there is limited information on the role of antidiabetic medications. Aim: We examined the association between type 2 diabetes, antidiabetic medications, and the risk of colorectal cancer, considering also duration of exposures. Methods: We analyzed data derived from two companion case-control studies conducted in Italy and Spain between 2007 and 2013 on 1,147 histologically confirmed colorectal cancer cases and 1,594 corresponding controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by unconditional multiple logistic regression models, adjusted for socioeconomic factors and major potential confounding factors. Results: Overall, 14% of cases and 12% of controls reported a diagnosis of diabetes, corresponding to an OR of colorectal cancer of 1.21 (95% CI 0.95-1.55). The OR was 1.49 (95% CI 0.97-2.29) for a duration of diabetes of at least 15 years. The OR was 1.53 (95% CI 1.06-2.19) for proximal colon cancer, 0.94 (95% CI 0.66-1.36) for distal colon cancer, and 1.32 (95% CI 0.94-1.87) for rectal cancer. In comparison with no use, metformin use was associated with a decreased colorectal cancer risk (OR 0.47, 95% CI 0.24-0.92), while insulin use was associated with an increased risk (OR 2.20, 95% CI 1.12-4.33); these associations were stronger for longer use (OR 0.36 and 8.18 for ≥10 years of use of metformin and insulin, respectively). Conclusion: This study shows evidence of a positive association between diabetes and colorectal cancer, mainly proximal colon cancer. Moreover, it indicates a negative association between colorectal cancer and metformin use and a positive association for insulin use.

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KW - Colorectal cancer

KW - Diabetes

KW - Insulin

KW - Metformin

KW - Risk factor

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