Type 2 Diabetes and Colorectal Cancer Risk

Bridging diabetes and cancer: harnessing biomarkers as dual sentinels for diagnosis, prognosis, and therapeutic advancements

The complex two-way relationship between diabetes mellitus (DM) and cancer poses a significant global health challenge. Shared mechanisms such as hyperinsulinemia, chronic inflammation, and oxidative stress create an environment that fosters cancer development, increasing the risk for certain cancers in individuals with diabetes, including pancreatic, colorectal, breast, liver, and endometrial malignancies. In this context, biomarkers emerge as essential tools, offering a means to untangle the connections between these two conditions by providing insights into early detection, diagnosis, prognosis, and treatment monitoring. For diabetic patients, biomarkers are particularly valuable as they help differentiate between changes caused by cancer and those driven by metabolic imbalances, illuminating disease evolution. This review examines the unique challenges encountered by diabetic patients with cancer, emphasizing the contributions of targeted biomarkers in identifying cancer subtypes, predicting outcomes, and guiding treatment decisions. We explore organ-specific biomarker profiles across various cancers, including pancreatic, colorectal, breast, liver, and lung, highlighting their potential to enhance diagnostic precision and enable personalized treatment strategies. Ultimately, we aim to illustrate how a deeper understanding of biomarker signatures can inform innovative clinical approaches and improve care for patients facing the dual burden of diabetes and cancer.

Recent advances in the development and application of colorectal cancer mouse models

Colorectal cancer (CRC) remains a significant global health challenge, necessitating the development of reliable preclinical models to advance mechanistic understanding and therapeutic innovation. This review comprehensively examines the diverse spectrum of rodent models employed in CRC research, focusing on their unique characteristics, applications, and translational relevance. We systematically evaluate conventional models, including carcinogen-induced models and genetically engineered mouse models (GEMMs), which have been instrumental in elucidating tumorigenic pathways and genetic drivers. Furthermore, we highlight the emergence of patient-derived xenografts (PDX) as a transformative tool for recapitulating tumor heterogeneity and predicting clinical responses. The review also explores metastatic models, which are critical for studying advanced disease, and spontaneous models that mimic natural tumor progression. Additionally, we discuss the growing utility of composite animal models, which integrate multiple methodologies to better reflect the complexity of human CRC. By comparing the strengths and limitations of each model system, this review provides a framework for selecting appropriate models based on specific research objectives. Collectively, these preclinical platforms have significantly advanced our understanding of CRC biology and continue to drive the development of targeted therapies and personalized treatment strategies.

Chronic Conditions and Racially Biased Healthcare Experiences Impact Breast Cancer and Colorectal Cancer Screening Across Racial/Ethnic Groups

INTRODUCTION

Mammogram uptake and colorectal cancer (CRC) screening are influenced by racially biased healthcare experiences and presence of chronic conditions; moreover, there is racially/ethnically disparate uptake of each. The current study aimed to expand on extant literature by examining the association between racially biased healthcare experiences and chronic conditions across three racial/ethnic groups.

METHODS

We conducted weighted multivariable logistic regressions to examine the interaction between chronic conditions (none, cancer, other chronic conditions) and racially biased healthcare experiences (none, better, worse, other) on mammogram and CRC screening adherence across three racial/ethnic groups (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic/non-Hispanic Other [NHO]) using 2022 Behavioral Risk Factor Surveillance System data.

RESULTS

Among 42,053 and 86,033 eligible respondents for mammogram and CRC screening, most respondents had an up-to-date mammogram (77.4%) or CRC test (67.0%). In adjusted analysis, Hispanic/NHO respondents with conditions other than cancer and felt they were treated worse than other races while seeking healthcare had a decreased odds of having an up-to-date mammogram (OR 0.21, 95% CI 0.09-0.46). NHW respondents with cancer who felt they were treated better than other races while seeking healthcare had increased odds of having an up-to-date mammogram (OR 1.70, 95% CI 1.11-2.60). All significant associations (i.e., p < 0.05) between chronic conditions and CRC screening were positive, regardless of treatment while seeking healthcare across racial/ethnic groups.

CONCLUSIONS

Culturally sensitive interventions aimed at improving patient-centered communication may improve mammogram and CRC screening adherence, particularly for racially/ethnically minoritized groups.

Type II diabetes and metformin use does not affect colorectal cancer prognosis

Previous studies on the impact of metformin and colorectal cancer (CRC) outcomes have been limited by small size and confounding by indication, yielding inconsistent results. The aim of this study was to assess whether diabetes and pre-diagnostic metformin use influence CRC prognosis. The study was performed using the Colorectal Cancer Data Base Sweden, a register-linkage originating from the Swedish Colorectal Cancer Register with linkage to national health care registers and demographic registers. All adult patients diagnosed with primary non-metastatic CRC between 2007 and 2016, treated with curative surgery, were identified and followed up from 90 days post-surgery until December 31, 2022. Antidiabetic medication use was defined as dispensed prescription ≥6 months of use within 1 year of surgery. Type II diabetes mellitus (T2DM) patients were divided into three treatment groups (i) diet only, (ii) metformin user, and (iii) non-metformin user. Cox regression models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for time to recurrence, CRC-specific, and all-cause mortality, adjusted for relevant covariates. Of 33,028 non-metastatic CRC patients, 4539 (13.7%) had T2DM, with 1745 using metformin. A T2DM diagnosis was not associated with increased recurrence rate or CRC-specific mortality; HRadj 0.97 (95% CI 0.89-1.06) and HRadj 0.95 (95% CI 0.87-1.05), respectively, compared with non-diabetic patients. Furthermore, no association between T2DM, metformin use, and recurrence or CRC-specific mortality was seen, HRadj 0.98 (95% CI 0.86-1.12) and HRadj 0.98 (95% CI 0.85-1.13), respectively. T2DM is not associated with an elevated recurrence or CRC-specific mortality. Additionally, metformin use does not impact CRC prognosis.

Epidemiology of colorectal cancer: A review with special emphasis on India

Colorectal cancer (CRC) is a common malignancy and cause for death around the world. In India, it ranks as the fourth most incident cancer in both sexes, with 64,863 cases and 38,367 deaths in 2022. With such high mortality, CRC survival in India is way lesser than that of developed countries. While western countries are facing an overall decline in CRC incidence, various regions in India are seeing an increasing trend. Within India, urban regions have markedly higher incidence than rural. Risk factors include consumption of red and processed meat, fried and sugary food, smoking and alcohol, comorbidities such as obesity, diabetes and inflammatory bowel disease (IBD), family history of CRC, adenomas and genetic syndromes, radiation exposure, pesticides and asbestos. Consumption of nutrient-rich well-balanced diets abundant in vegetables, dairy products, whole grains, nuts and legumes combined with physical activity are protective against CRC. Besides these, metformin, aspirin and micronutrient supplements were inversely associated with the development of CRC. Since a considerable proportion of CRC burden is attributed to modifiable risk factors, execution of population level preventive strategies is essential to limit the growing burden of CRC. Identifying the necessity, in this review, we explore opportunities for primary prevention and for identifying high-risk populations of CRC to control its burden in the near future.

Early diagnosis of type 2 diabetes mellitus in patients with psoriasis: Construction of a multifactorial diagnostic model

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a significant comorbidity of psoriasis that exerts a long-term detrimental effect on patients. Early T2DM detection in psoriasis patients is essential for timely medical intervention and the prevention of further complications.

OBJECTIVE

To develop a diagnostic model and introduce a web-based calculator for assessing the risk of T2DM in patients with psoriasis.

METHODS

A diagnostic model was constructed using the least absolute shrinkage and selection operator and logistic regression on data from 17,124 patients with psoriasis from 49 hospitals. The model's performance was evaluated using receiver operating characteristic curve, decision curve analysis, and clinical impact curve.

RESULTS

Eleven significant independent predictors were identified in our model. The area under the receiver operating characteristic curve of this model was 0.875 (95% confidence interval: 0.862-0.889), and the result of Hosmer-Lemeshow goodness of fit test showed a P-value of 0.06. Within the threshold probability of 0-0.2, the diagnostic model showed a significant net benefit.

LIMITATIONS

The limitations of retrospective studies, including a potential data bias to arise during pandemics, must be considered.

CONCLUSION

A multifactorial diagnostic model for diagnosing T2DM in patients with psoriasis was constructed to help clinicians make better decisions.

Identification of Diagnostic Biomarkers for Colorectal Polyps Based on Noninvasive Urinary Metabolite Screening and Construction of a Nomogram

PURPOSE/BACKGROUNDS

Colorectal polyps (CRPs) are precursors to colorectal cancer (CRC), and early detection is crucial for prevention. Traditional diagnostic methods are invasive, prompting a need for noninvasive biomarkers. This study aimed to identify urinary metabolite biomarkers for diagnosing CRPs and construct a diagnostic nomogram based on noninvasive urinary metabolite screening.

PATIENTS AND METHODS

A total of 192 participants, including 64 CRP patients and 128 healthy controls, were recruited. Urine samples were analyzed using untargeted gas chromatography-mass spectrometry (GC-MS) and ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Metabolite screening was performed using weighted gene coexpression network analysis (WGCNA), least absolute shrinkage and selection operator (LASSO), and support vector machine-recursive feature elimination (SVM-RFE). A diagnostic nomogram was developed based on identified metabolites, and its performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

RESULTS

A total of 350 metabolites were identified, with 7 key metabolites significantly associated with CRP. Multivariate logistic regression analysis identified Saccharin (OR = 48.3, 95% CI: 4.44-525.32) and N-omega-acetylhistamine (OR = 27.91, 95% CI: 2.31-337.06) as significant risk factors for CRP, while N-methyl-L-proline, trimethylsilyl ester (OR = 0.08, 95% CI: 0.01-0.8) was a protective factor. A nomogram incorporating these metabolites demonstrated strong discriminatory power, with AUC values of 0.974 and 0.960 in the training and validation sets, respectively. Calibration plots and DCA confirmed the model's accuracy and clinical utility.

CONCLUSIONS

This study successfully identified seven urinary metabolites as potential noninvasive biomarkers for CRP. The constructed diagnostic nomogram, based on these metabolites, offers high predictive accuracy and clinical applicability, providing a promising tool for the early detection of CRP.

Impact of SGLT2 inhibitors on survival in gastrointestinal cancer patients undergoing chemotherapy and/or radiotherapy: a real-world data retrospective cohort study

BACKGROUND

The role of sodium-glucose co-transporter 2 inhibitor (SGLT2i) drugs in the management of diabetes and cardiovascular disease is well-established, but emerging evidence suggests potential effects on cancer outcomes, including gastrointestinal (GI) cancers. We conducted an extensive, sex-oriented, real-world data analysis to investigate whether SGLT2i can enhance GI cancer outcomes when used alongside standard therapies such as chemotherapy and radiotherapy.

METHODS

The study applied a retrospective cohort design with data from the TriNetX research database ( https://trinetx.com ), examining GI cancer patients treated with chemotherapy and/or radiotherapy between 2013 and 2023. The intervention cohort consisted of Gl cancer patients who received SGLT2i, while the control cohort did not. A 5-year follow-up period was used, and baseline characteristics were balanced using a 1:1 propensity score matching technique. Cox proportional-hazards and logistic regression models assessed mortality and morbidity risks between the cohorts.

RESULTS

The study included 6,389 male and 3,457 female patients with GI cancer (ICD-10: C15-C25). The use of SGLT2i was significantly associated with improved survival for both male (HR 0.568; 95% CI 0.534-0.605) and female (HR 0.561; 95% CI 0.513-0.614) patients undergoing chemotherapy and/or radiotherapy. SGLT2i use also correlated significantly with lower hospitalisation rates both in male (OR 0.684; 95% CI 0.637-0.734) and female (OR, 0.590; 95% CI 0.536-0.650) patients. The analysis of GI cancer subtypes also demonstrated similar benefits, without significant adverse effects.

CONCLUSIONS

Repurposing SGLT2 inhibitors for cancer treatment could potentially improve outcomes for GI cancer patients without causing significant side effects. Further clinical trials are needed to confirm these findings and establish the optimal condition for its application in GI cancer treatment.

Anemia in diabetes mellitus: Pathogenetic aspects and the value of early erythropoietin therapy

Anemia is a frequent, yet increasingly recognized, comorbidity in diabetes mellitus (DM), with prevalence often driven by multifactorial mechanisms. Hematinic deficiencies, common in this population, may arise from associated comorbidities or medications, such as metformin, as well as other drugs commonly employed for DM-related conditions. Among contributing factors, diabetic kidney disease (DKD) plays a pivotal role, with anemia developing more frequently and being more pronounced in earlier stages, than in CKD of other causes. This enhanced susceptibility stems primarily from the combined impact of impaired renal oxygen sensing and deficient erythropoietin (EPO) production linked to tubulointerstitial fibrosis. Additional mechanisms comprise glomerular dysfunction, shortened erythrocyte lifespan, uremia-induced bone marrow suppression, and increased bleeding risk. DM is also recognized as a chronic low-grade inflammatory condition, with its inflammatory burden driving iron maldistribution, suppression of erythropoiesis, and resistance to EPO. The diagnostic approach of anemia in DM mirrors that in the general population. Addressing modifiable causes such as hematinic deficiencies, and other chronic conditions, such as DKD and bone marrow disorders, is paramount. In total, the underlying pathophysiology of anemia in DM primarily reflects a state of absolute or relative EPO deficiency and/or diminished bone marrow responsiveness, effectively corresponding to 'anemia of chronic disease. Early initiation of EPO therapy, even in DM patients without overt DKD, may mitigate disease progression and improve outcomes. Future research should focus on diabetes-specific strategies integrating optimal EPO use, potentially implementing targeted management of renal and inflammatory contributors to anemia.

Impact of dipeptidyl peptidase-4 inhibitors on incidence of colorectal cancer in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Background

The association between dipeptidyl peptidase-4 inhibitors (DPP-4i) exposure and the risk of colorectal cancer (CRC) in patients with type 2 diabetes mellitus (T2DM) is unclear.

Objectives

This meta-analysis aims to investigate the relationship between DPP-4i exposure and the incidence of CRC in patients with T2DM.

Design

A systematic review and meta-analysis.

Methods

A comprehensive search of electronic databases, including PubMed, Web of Science, EMBASE, and ScienceDirect, was conducted up to March 2024. The studies including randomized clinical trials (RCTs), cohort studies, and case-control studies were retrieved. The odds ratio (OR) was calculated using Stata 12.0 statistical software. The primary outcome assessed was the incidence of CRC.

Results

This meta-analysis incorporated six retrospective cohort studies and two case-control studies. The findings indicate that the incidence of CRC in the DPP-4i exposure group was significantly higher than that in the control group (OR = 1.11, 95% CI: 1.02-1.21, p = 0.013). Subgroup analysis revealed that both male (OR = 2.07, p < 0.001) and female participants (OR = 1.49, p = 0.05) in the DPP-4i exposure group exhibited a significantly higher incidence of CRC compared to the control group. Among participants younger than 65 years, the incidence of CRC was markedly elevated in the exposure group (OR = 2.81, p < 0.001). Furthermore, when the exposure duration was less than 1 year, the CRC incidence in the exposure group surpassed that of the control group (OR = 1.24, p = 0.005). When sulfonylureas (SU) were used as control drugs, the incidence of CRC was higher in the exposure group (OR = 1.10, p = 0.017).

Conclusion

There is a potential correlation between DPP-4i exposure and increased incidence of CRC in T2DM patients. This association appears to be influenced by gender, age, duration of exposure, and the choice of control medications. Therefore, attention should be paid to colorectal diseases when DPP-4i is employed in the clinic.

Trial registration

The meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42024535292.

Predictive Model for Hypoglycaemia Risk in Type 2 Diabetes Mellitus Patients During the Peri-Colonoscopy Period: A Retrospective Cohort Study

AIMS

To identify factors influencing hypoglycaemia in patients with type 2 diabetes mellitus (T2DM) undergoing colonoscopy and to construct a predictive model for assessing hypoglycaemia risk.

DESIGN

A retrospective cohort study.

METHODS

We retrospectively collected data on 598 T2DM patients who underwent colonoscopy and randomised them into a developmental cohort and a validation cohort in a 7:3 ratio. We used multivariate logistic regression to develop a predictive model for hypoglycaemia during colonoscopy and identify independent predictors in pre- and post-colonoscopy hypoglycaemia groups.

RESULTS

We identified 112 of 598 (18.7%) T2DM patients who experienced hypoglycaemia during the peri-colonoscopy period: 43 pre-colonoscopy, 61 post-colonoscopy and 8 at both junctures. Ultimately, five predictors-insulin, SGLT2 inhibitors, fasting after colonoscopy, fasting C-peptide and estimated glomerular filtration rate (eGFR)-were integrated into the predictive model. The AUC for predicting hypoglycaemia was 0.78 (95% CI, 0.71-0.84) and 0.82 (95% CI, 0.74-0.90) in the development and validation cohort, respectively. Variables associated with pre-colonoscopy hypoglycaemia included SGLT2 inhibitors, fasting C-peptide and eGFR, whereas the post-colonoscopy hypoglycaemia group was associated with metformin, duration of diabetes, fasting C-peptide and fasting after the examination.

CONCLUSION

This study successfully developed and validated a predictive model for assessing hypoglycaemia risk in T2DM patients during peri-colonoscopy.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Early identification of patients at high risk for peri-colonoscopy hypoglycaemia allows nurses to implement personalised preventive strategies. The predictive model enables clinical nurses to deliver tailored interventions based on individual risk factors, potentially reducing hypoglycaemia-related complications and improving patient safety outcomes.

IMPACT

This study provides nurses with a validated risk prediction tool for identifying high-risk type 2 diabetes patients during colonoscopy, enabling targeted blood glucose monitoring protocols and preventive interventions in clinical practice.

REPORTING METHOD

This study follows the STROBE guidelines for reporting cohort studies.

PATIENT OR PUBLIC CONTRIBUTION

Diabetes patients contributed electronic health record datasets.

Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with predictions to 2046

BACKGROUND

Metabolic risks are significant factors associated with colorectal cancer. This study aimed to assess global, regional and national burden for CRC attributable to metabolic risks from 1990 to 2021 and to predict mortality by 2046.

METHODS

Data from the Global Burden of Disease Study 2021 were used to quantify deaths, disability-adjusted life years (DALYs), and age-standardized rates of CRC due to metabolic risk factors, disaggregated by sex, age, region, country/territory, and sociodemographic index (SDI). The average annual percentage change (AAPC) was used to analyze temporal trends from 1990 to 2021. Metabolic risks include high fasting plasma glucose (FPG) and high body mass index (BMI). Future mortality trends up to 2046 were forecast using age-period-cohort models.

RESULTS

Globally, CRC deaths attributable to metabolic risks increased 2.47-fold, rising from 73,443 in 1990 to 181,689 in 2021. The global age-standardized mortality rates (ASMRs) and age-standardized rates of DALYs (ASDRs) of CRC attributable to high FPG and ASDRs attributable to high BMI increased from 1990 to 2021. The ASMRs and ASDRs of males was higher than that of females, with increasing trends. Central Europe had the highest ASMRs and ASDRs of CRC attributable to metabolic risks in 2021. Most regions and countries showed increasing trends in ASMR and ASDR for CRC due to metabolic risks, with Andean Latin America, Southeast Asia, and Cabo Verde increasing the most. High-SDI regions had the largest burden of CRC attributable to metabolic risks, while burden of other SDI regions have been significantly increased. A positive association was observed between SDI and age-standardized rates (ASMR: RFPG = 0.803, RBMI = 0.752; ASDR: RFPG = 0.812, RBMI = 0.756). By 2046, the ASMR of CRC attributable to high FPG was projected to remain stable and the ASMR due to high BMI was expected to see a slightly increase.

CONCLUSION

Colorectal cancer deaths and DALYs attributable to metabolic risk factors remain high, particularly in males and high-SDI regions. Further researches into the metabolic mechanisms of CRC and effective treatment strategies are needed.

The Economic Burden of Colorectal Cancer in Type 2 Diabetes Mellitus (T2DM) in Shanghai, China

OBJECTIVE

This study aimed to analyze disease cost levels among colorectal cancer (CRC) patients, examining differences in disease costs between those with type 2 diabetes mellitus (T2DM) and those without T2DM while considering various demographic characteristics.

METHODS

The study included respondents from colorectal cancer patients diagnosed and managed within the population-based cancer registry system of the Shanghai Municipal Center for Disease Control and Prevention from 2020 to 2022. Diabetic colorectal cancer cases were matched with nondiabetic colorectal cancer controls using propensity scores, maintaining a 1:1 ratio between cases and controls; bias for the majority of the matched variables is below 10%. Direct, indirect, and intangible costs were estimated for study subjects.

RESULTS

After propensity score matching, the analysis encompassed 376 cases of T2DM-related CRC and 376 non-T2DM CRC cases. The T2DM group exhibited higher direct medical costs (¥57,059.65 vs. ¥48,933.93, p < 0.05), direct nonmedical costs (¥9292.45 vs. ¥7969.35), indirect costs (¥300.13 vs. ¥241.11), intangible costs (¥3601.70 vs. ¥2631.96), and total disease costs (¥70,253.93 vs. ¥59,776.36, p < 0.05) compared to the non-T2DM group. In Stage II CRC, direct medical costs were ¥74,008.39 for the T2DM group versus ¥57,368.84 for the non-T2DM group. Among surgical patients, direct medical costs were ¥57,658.81 for the T2DM group versus ¥1337.00 for the non-T2DM group, and ¥49,061.52 for the non-T2DM surgical group versus ¥1089.00 for the non-T2DM nonsurgical group.

CONCLUSION

Colorectal cancer imposes a substantial economic burden. Patients with CRC and concurrent T2DM experience a higher economic burden compared to nondiabetic patients. Notably, individuals with both T2DM and Stage II cancer face a significantly higher economic burden, whereas surgical patients exhibit a significantly greater disease burden than nonsurgical patients. Efforts should concentrate on primary prevention and secondary prevention to alleviate the economic burden associated with colorectal cancer.

A Comprehensive Review of the Effects of Diabetes Mellitus on the Gastrointestinal System

Diabetes mellitus (DM) is a worldwide epidemic, making it a major non-communicable disease of public health concern. DM is a chronic disease affecting various organs of the body, leading to increased morbidity and frequently causing patients to seek medical care. Patients with DM often suffer from gastrointestinal disturbances, indicating the involvement of the gastrointestinal system (GIS). Common effects on the gastrointestinal tract (GIT) include esophageal dysmotility, gastroesophageal reflux disease (GERD), non-alcoholic fatty liver disease (NAFLD), glycogenic hepatopathy, gastroparesis, and enteropathy. Despite the high rates of GIT complications associated with diabetes, they are often under-recognized by physicians, leading to suboptimal treatment and a poor quality of life for patients. This article reviews the GIT manifestations of DM from the esophagus to the anal canal, including their pathophysiology and current management strategies.

Application value of high-pressure-resistant peripherally inserted central catheters in enhanced computer tomography of diabetic patients with malignant tumors

BACKGROUND

Individuals with diabetes mellitus have a higher risk of developing malignant tumors, and diagnosing these tumors can be challenging.

AIM

To confirm the benefits of using peripherally inserted central catheters (PICCs) in contrast-enhanced computerized tomography (CECT) for diagnostic imaging in diabetic patients with malignant tumors and to provide a research basis for follow-up research.

METHODS

This retrospective study analyzed 204 diabetic patients with malignancies treated at The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, from January 2024 to June 2024. The patients were divided into two groups: A control group (n = 102) with indwelling peripheral intravenous catheters and a research group (n = 102) with high-pressure-resistant PICC. The study compared baseline data, the incidence of iodine contrast extravasation during CECT, the incidence of adverse events (discomfort, redness and swelling at the puncture site, and blood oozing), imaging quality, nursing time, intubation success rate, number of venipuncture attempts, and catheter maintenance cost.

RESULTS

Male patients accounted for 51.96% in the control group and 55.88% in the research group; the average age was (59.68 ± 11.82) years in the control group and (61.41 ± 12.92) years in the research group; the proportions of lung cancer, colorectal cancer, and gastric cancer patients in the control group were 42.16%, 38.24%, and 19.61%, respectively, while those in the research group were 34.31%, 37.25%, and 28.43%, respectively. Except for the gender distribution, age, and cancer type mentioned above, other general information such as underlying diseases, puncture location, and long-term chemotherapy shows no significant differences as tested (P > 0.05). The results showed that the research group had significantly reduced incidence of iodine contrast extravasation (7 vs 1, P = 0.031), similar incidence of adverse events (11 vs 7, P = 0.324), reduced nursing time [(18.50 ± 2.68) minutes vs (13.26 ± 3.00) minutes, P = 0.000], fewer venipuncture attempts [(2.21 ± 0.78) times vs (1.49 ± 0.58) times, P = 0.000], lower catheter maintenance cost [(1251.79 ± 205.47) China yuan (CNY) vs (1019.25 ± 117.28) CNY, P = 0.000], increased intubation success rate (16.67% vs 58.82%, P = 0.000), and better imaging quality (85.29% vs 94.12%, P = 0.038).

CONCLUSION

High-pressure-resistant PICCs can lessen the physical burden of diabetic patients during nursing, reduce treatment costs, and improve the efficiency and quality of imaging for diagnosis malignant tumors.

SGLT2i and Primary Prevention of Cancer Therapy-Related Cardiac Dysfunction in Patients With Diabetes

Background

Specific cancer treatments can lead to cancer therapy-related cardiac dysfunction (CTRCD). Sodium glucose cotransporter-2 inhibitors (SGLT2is) can potentially prevent these cardiotoxic effects.

Objectives

This study sought to determine whether SGLT2i use is associated with a lower incidence of CTRCD in patients with type 2 diabetes mellitus (T2DM) and cancer, exposed to potentially cardiotoxic antineoplastic agents, and without a prior documented history of cardiomyopathy or heart failure.

Methods

We conducted a retrospective analysis of patients aged ≥18 years within the TriNetX database with T2DM, cancer, exposure to cardiotoxic therapies, and no prior documented history of cardiomyopathy or heart failure. Patients were categorized by SGLT2i use. After propensity score matching, outcomes were compared over 12 months using Cox proportional HRs. Subgroup analyses focusing on different cancer therapy classes were performed.

Results

The study included 8,675 propensity-matched patients in each cohort (mean age = ∼65 years, 42% females, 71% White, ∼19% gastrointestinal malignancy, and ∼25% anthracyclines). Patients prescribed SGLT2is had a lower risk of developing CTRCD (HR: 0.76: 95% CI: 0.69-0.84). SGLT2is also reduced heart failure exacerbations (HR: 0.81; 95% CI: 0.72-0.90), all-cause mortality (HR: 0.67; 95% CI: 0.61-0.74), and all-cause hospitalizations/emergency department visits (HR: 0.93; 95% CI: 0.89-0.97). Subgroup analyses also demonstrated reduced CTRCD risk across various classes of cancer therapies in patients prescribed SGLT2is.

Conclusions

SGLT2i administration was associated with a significantly decreased risk of developing CTRCD in patients with T2DM and cancer.

Type 2 diabetes and colorectal cancer: genetic causality explored via Mendelian randomization

BACKGROUND

The global burden of type 2 diabetes (T2D) and colorectal cancer (CRC) continues to rise. Observational studies have suggested a link between T2D and an elevated risk of CRC. However, these studies are often susceptible to confounding factors and reverse causation, leading to inconsistent findings. There is a specific gap in knowledge regarding the causal nature of the relationship between T2D and CRC, which this study aims to address using a more robust approach. To fill this gap, we employed Mendelian randomization (MR), a method that uses genetic variants as instrumental variables (IVs) to infer causality, providing clearer insight into the genetic links between T2D and CRC.

METHODS

A bidirectional MR study was conducted to investigate the causal links between T2D and CRC. Genetic instruments for T2D were derived from two large genome-wide association studies (GWAS) with a total sample size of X individuals, and CRC genetic instruments were obtained from a GWAS with Y individuals. The MR analysis utilized the inverse-variance weighted (IVW) method as the primary analysis, alongside sensitivity analyses such as heterogeneity and pleiotropy analysis to account for potential pleiotropy and bias. Additionally, to enhance the robustness of the findings and minimize the influence of data from different GWAS sources, we performed a meta-analysis of the IVW results.

RESULTS

The MR analysis and meta-analysis revealed that genetically predicted T2D is associated with an increased risk of CRC (Pooled ORIVW = 1.07, 95% CI 1.02-1.12, P = 0.003). However, the reverse analysis did not indicate a causal effect of genetically predicted CRC on T2D risk (Pooled ORIVW = 1.02, 95% CI 0.96-1.09, P = 0.469). Sensitivity analyses supported the robustness of these findings, indicating no evidence of heterogeneity or pleiotropic effects that could bias the results (all P > 0.05).

CONCLUSION

Our bidirectional MR study and meta-analysis provide evidence that T2D increases the risk of colorectal cancer. However, there is no evidence to support a reverse causal relationship. These findings highlight the importance of monitoring and managing T2D as part of CRC prevention strategies.

Association of low-carbohydrate diet score and carbohydrate quality index with colorectal cancer risk: a large-scale case-control study

PURPOSE

Carbohydrate intake has been linked to colorectal cancer (CRC) risk, with variations depending on the quantity and quality of carbohydrates consumed. This study aimed to investigate the association between carbohydrate quantity and quality, using the low-carbohydrate diet score (LCD) and carbohydrate quality index (CQI), and the risk of CRC in the Chinese population.

METHODS

We conducted a case-control study in Guangzhou, China, with 2,799 CRC cases and an equal number of sex- and age-matched controls. Dietary data were collected using a validated food frequency questionnaire to derive the LCD and CQI, assessing the quantity and quality of carbohydrate intake separately. Odds ratios (OR) and 95% confidence interval (CI) for CRC risk were estimated using unconditional logistic regression models, and restricted cubic splines were used to explore potential non-linear relationships.

RESULTS

The results demonstrated that higher adherence to the overall LCD score, plant-based LCD score, and CQI was associated with a lower risk of CRC. The adjusted ORs (95%CIs) for the highest quintile of intake in comparison with the lowest quintile were 0.76 (0.63, 0.91) for the overall LCD score, 0.61 (0.50, 0.74) for the plant-based LCD score, and 0.70 (0.58,0.84) for the CQI, respectively. However, the animal-based LCD did not show a significant association with CRC risk, with the adjusted OR (95%CI) for the highest quintile compared to the lowest being 0.98 (0.81, 1.18). Restricted cubic splines analysis showed non-linear associations of the overall LCD score, animal-based LCD score, and plant-based LCD score with CRC risk. In contrast, a linear relationship was observed between CQI and CRC risk (Pnonlinear = 0.594).

CONCLUSIONS

Our findings indicate that the overall LCD score, the plant-based LCD score, and the CQI were inversely associated with the risk of CRC.

Hyperglycemic environments directly compromise intestinal epithelial barrier function in an organoid model and hyaluronan (∼35 kDa) protects via a layilin dependent mechanism

BACKGROUND

Metabolic syndrome and diabetes in obese individuals are strong risk factors for development of inflammatory bowel disease (IBD) and colorectal cancer. The pathogenic mechanisms of low-grade metabolic inflammation, including chronic hyperglycemic stress, in disrupting gut homeostasis are poorly understood. In this study, we sought to understand the impact of a hyperglycemic environment on intestinal barrier integrity and the protective effects of small molecular weight (35 kDa) hyaluronan on epithelial barrier function.

METHODS

Intestinal organoids derived from mouse colon were grown in normal glucose media (5 mM) or high glucose media (25 mM) to study the impact of hyperglycemic stress on the intestinal barrier. Additionally, organoids were pretreated with 35 kDa hyaluronan (HA35) to investigate the effect of hyaluronan on epithelial barrier under high glucose stress. Immunoblotting as well as confocal imaging was used to understand changes in barrier proteins, quantitative as well as spatial distribution, respectively. Alterations in barrier function were measured using trans-epithelial electrical resistance and fluorescein isothiocyanate flux assays. Untargeted proteomics analysis was performed to elucidate mechanisms by which HA35 exerts a protective effect on the barrier. Intestinal organoids derived from receptor knockout mice specific to various HA receptors were utilized to understand the role of HA receptors in barrier protection under high glucose conditions.

RESULTS

We found that high glucose stress decreased the protein expression as well as spatial distribution of two key barrier proteins, zona occludens-1 (ZO-1) and occludin. HA35 prevented the degradation or loss of ZO-1 and maintained the spatial distribution of both ZO-1 and occludin under hyperglycemic stress. Functionally, we also observed a protective effect of HA35 on the epithelial barrier under high glucose conditions. We found that HA receptor, layilin, was involved in preventing barrier protein loss (ZO-1) as well as maintaining spatial distribution of ZO-1 and occludin. Additionally, proteomics analysis showed that cell death and survival was the primary pathway upregulated in organoids treated with HA35 under high glucose stress. We found that XIAP associated factor 1 (Xaf1) was modulated by HA35 thereby regulating apoptotic cell death in the intestinal organoid system. Finally, we observed that spatial organization of both focal adhesion kinase (FAK) as well as F-actin was mediated by HA35 via layilin.

CONCLUSION

Our results highlight the impact of hyperglycemic stress on the intestinal barrier function. This is of clinical relevance, as impaired barrier function has been observed in individuals with metabolic syndrome. Additionally, we demonstrate barrier protective effects of HA35 through its receptor layilin and modulation of cellular apoptosis under high glucose stress.

Effect of diabetes mellitus type 2 and sulfonylurea on colorectal cancer development: a case-control study

BACKGROUND AND AIMS

Colorectal cancer (CRC) is a significant global health concern, with studies estimating a rise in new cases to 2.5 million by 2035. Type 2 diabetes (T2D) is also a growing issue, with an estimated 642 million adults affected by 2040. However, the relationship between T2D, its medications, and CRC remains unclear.

MATERIALS AND METHODS

This case-control study includes 810 controls without CRC and 684 cases with CRC admitted to Rasoul-Akram and Firouzgar Hospitals from September 2019 to 2023. Adjusted and unadjusted odds ratios (OR) were calculated to investigate the effect of T2D and sulfonylurea consumption on the chance of CRC development, using univariate and multivariate logistic regression analyses. The relationship between T2D and the clinicopathological features of the tumor was investigated.

RESULTS

The results show that the effect of T2D on CRC is significant based on unadjusted OR (OR = 1.39, CI = 1.07, 1.81) and insignificant in adjusted OR (OR = 0.67, CI = 0.37, 1.20). The effect of sulfonylurea consumption on CRC was significant in both unadjusted (OR = 2.39, CI = 1.40, 4.09) and adjusted ORs (OR = 2.35, CI = 1.12, 4.91). All analyses related to the relationship between T2D and tumor clinicopathological characteristics were insignificant.

CONCLUSION

This study found an insignificant association between type 2 diabetes and the chance of CRC development in an adjusted state. Sulfonylurea consumption was also associated with a higher chance of CRC development among patients with T2D. These findings have implications for clinical practice and public health strategies in CRC prevention for patients with T2D.

National trends in type 2 diabetes mellitus stratified by central adiposity using waist-to-height ratio in South Korea, 2005-2022

Studies investigating the association between type 2 diabetes mellitus and central adiposity are lacking. Therefore, this study aimed to investigate trends in type 2 diabetes mellitus stratified by central adiposity using waist-to-height ratio (WHtR). Trends in type 2 diabetes mellitus were examined by central adiposity, using WHtR, with data from the Korea National Health and Nutrition Examination Survey (2005-2022). Individuals aged 30 years and over who participated in the survey were selected. Type 2 diabetes mellitus was identified based on serum glucose or HbA1c levels, the use of diabetes medications, or a prior diagnosis by a physician. Weighted β-coefficients or odd ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess changes in disease prevalence. A total of 79,368 participants were included in the database (female: 45,163 [56.9%]). from 2005 to 2022, the prevalence of type 2 diabetes mellitus increased from 3.3 to 5.8% in the healthy central adiposity group, from 11.2 to 17.1% in the increased central adiposity group, and from 18.0 to 26.7% in the high central adiposity group. Males, older population, lower education level, lower household income, and smoking are associated with a higher risk of type 2 diabetes. In the high central adiposity group, overweight and obese individuals had higher susceptibility than underweight or normal-weight individuals, with ORs of 5.85 (95% CI, 2.54-13.47) and 8.24 (3.79-17.94), respectively. The prevalence of type 2 diabetes mellitus has increased in all central adiposity groups in the past decade. This underscores the need for tailored interventions to address disparities and improve diabetes management in at-risk populations.

Negative prognostic impact of tumor deposits in stage III colorectal cancer patients

BACKGROUND

The prognostic value of tumor deposits (TDs) in stage III colorectal cancer (CRC) patients is poorly described based on the current tumor node metastasis (TNM) stage system.

MATERIALS AND METHODS

Based on the data from the Surveillance, Epidemiology, and End Result (SEER) database between 2010 to 2020 and local hospital between 2006 to 2022, the clinicopathological features of stage III CRC patients with TDs were screened by Chi-square test. Kaplan-Meier curves were performed to describe the significant difference in overall survival (OS) among the different groups, and log-rank tests were used to compare the cumulative survival distributions.

RESULT

Patients with TDs exhibited more aggressive tumors, characterized by advanced T staging (T3&T4), N staging (N2), perineural invasion, and more advanced TNM stage. The presence of TDs was identified as a negative prognostic factor in stage III CRC patients, with the co-existence of TDs and lymph node metastasis associated the poorest prognosis. A pairwise comparison revealed no statistically significant difference between TD+N1a/b and N1c groups, while the OS of TD-LN+ (TD- N1a/b) patients was the most favorable within the N1 stage. Notably, patients with a single lymph node positive had a significantly better OS than those with a single TD positive.

CONCLUSION

The presence of tumor deposits was a negative prognostic factor in stage III colorectal cancer patients, and the significance of tumor deposits was underestimated in the current TNM staging system.

The association between neighborhood socioeconomic status and the risk of incidence and mortality of colorectal cancer: A systematic review and meta-analysis of 1,678,582 participants

OBJECTIVES

We conducted a systematic review and meta-analysis to evaluate the association between neighborhood socioeconomic status (n-SES) and the risk of incidence and mortality in colorectal cancer (CRC).

SETTING

A comprehensive literature search was performed using PubMed/MEDLINE, ISI Web of Science and Scopus without any limitation until October 11, 2023. Inclusion criteria consisted of observational studies in adult subjects (≥18 years) which provided data on the association between n-SES and CRC-related incidence and mortality. Relative risk (RR) and 95 % confidence interval (CI) were pooled by employing a random-effects model. We employed validated methods to assess study quality and publication bias, utilizing the Newcastle-Ottawa Scale for quality evaluation, subgroup analysis to find possible sources of heterogeneity, Egger's regression asymmetry and Begg's rank correlation tests for bias detection and sensitivity analysis.

RESULTS

Finally, 24 studies (21 cohorts and 3 cross-sectional studies) from seven different countries with 1678,582 participants were included. The analysis suggested that a significant association between lower n-SES and an increased incidence of CRC (RR=1.11; 95 % CI: 1.08, 1.14; I2=64.4 %; p<0.001; n=46). The analysis also indicated a significant association between lower n-SES and an increased risk of mortality of CRC (RR=1.21; 95 % CI: 1.16, 1.26; I2=76.4 %; p<0.001; n=23). Furthermore, subgroup analysis revealed that there was a significant association between lower n-SES and an increased risk of incidence of CRC in colon location (RR=1.06; 95 % CI: 1.02, 1.10; I2=0.0 %; p=0.001; n=8), but not rectal location. In addition, subgroup analysis for covariates adjustment suggested that body mass index, smoking, physical activity, alcohol intake, or sex adjustment may influence the relationship between n-SES and the risk of incidence and mortality in CRC.

CONCLUSION

Lower n-SES was found to be a contributing factor to increased incidence and mortality rates associated with CRC, highlighting the substantial negative impacts of lower n-SES on cancer susceptibility and health outcomes.

Associations between Diabetes Mellitus and Selected Cancers

Cancer is one of the major causes of mortality and is the second leading cause of death. Diabetes mellitus is a serious and growing problem worldwide, and its prevalence continues to grow; it is the 12th leading cause of death. An association between diabetes mellitus and cancer has been suggested for more than 100 years. Diabetes is a common disease diagnosed among patients with cancer, and evidence indicates that approximately 8-18% of patients with cancer have diabetes, with investigations suggesting an association between diabetes and some particular cancers, increasing the risk for developing cancers such as pancreatic, liver, colon, breast, stomach, and a few others. Breast and colorectal cancers have increased from 20% to 30% and there is a 97% increased risk of intrahepatic cholangiocarcinoma or endometrial cancer. On the other hand, a number of cancers and cancer therapies increase the risk of diabetes mellitus. Complications due to diabetes in patients with cancer may influence the choice of cancer therapy. Unfortunately, the mechanisms of the associations between diabetes mellitus and cancer are still unknown. The aim of this review is to summarize the association of diabetes mellitus with selected cancers and update the evidence on the underlying mechanisms of this association.

Metformin's role in lowering colorectal cancer risk among individuals with diabetes from the Southern Community Cohort Study

BACKGROUND

Metformin, utilized to manage hyperglycemia, has been linked to a reduced risk of colorectal cancer (CRC) among individuals with diabetes. However, evidence is lacking for non-Hispanic Black individuals and those with lower socioeconomic status (SES), who face elevated risk for both diabetes and CRC. In this study, we investigated the association between metformin use and incident CRC risk within the Southern Community Cohort Study (SCCS), a racially- and SES-diverse prospective cohort.

METHODS

Participants reported their diabetes diagnosis and medications, including metformin, upon enrollment (2002-2009) and during follow-up surveys approximately every five years. Incident cases of CRC were identified through state cancer registries and the National Death Index. Proportional hazards models were employed to explore the relationship between metformin use and CRC risk, adjusted for cancer risk factors.

RESULTS

A total of 25,992 participants with diabetes were included in the analysis, among whom 10,095 were taking metformin. Of these participants, 76% identified as non-Hispanic Black, and 60% reported household incomes <$15,000/year. Metformin use was associated with a significantly lower CRC risk (HR [95% CI]: 0.71 [0.55-0.93]), with consistent results for both colon (0.80 [0.59-1.07]) and rectal cancers (0.49 [0.28-0.86]). The protective association appeared to be stronger among non-Hispanic White individuals (0.51 [0.31-0.85]) compared to non-Hispanic Black participants (0.80 [0.59-1.08], p-interaction =.13). Additionally, a protective association was observed among obese individuals (BMI ≥30 kg/m2, 0.59 [0.43-0.82] but not among non-obese participants (0.99 [0.65-1.51], p-interaction =.05) CONCLUSION: Our findings indicate that metformin use is associated with a reduced risk of CRC in individuals with diabetes, including among those from predominantly low SES backgrounds. These results support previous epidemiological findings, and demonstrate that the protective association for metformin in relation to incident CRC likely generalizes to populations with higher underlying risk.

Metformin: From Diabetes to Cancer-Unveiling Molecular Mechanisms and Therapeutic Strategies

Metformin, a widely used anti-diabetic drug, has garnered attention for its potential in cancer management, particularly in breast and colorectal cancer. It is established that metformin reduces mitochondrial respiration, but its specific molecular targets within mitochondria vary. Proposed mechanisms include inhibiting mitochondrial respiratory chain Complex I and/or Complex IV, and mitochondrial glycerophosphate dehydrogenase, among others. These actions lead to cellular energy deficits, redox state changes, and several molecular changes that reduce hyperglycemia in type 2 diabetic patients. Clinical evidence supports metformin's role in cancer prevention in type 2 diabetes mellitus patients. Moreover, in these patients with breast and colorectal cancer, metformin consumption leads to an improvement in survival outcomes and prognosis. The synergistic effects of metformin with chemotherapy and immunotherapy highlights its potential as an adjunctive therapy for breast and colorectal cancer. However, nuanced findings underscore the need for further research and stratification by molecular subtype, particularly for breast cancer. This comprehensive review integrates metformin-related findings from epidemiological, clinical, and preclinical studies in breast and colorectal cancer. Here, we discuss current research addressed to define metformin's bioavailability and efficacy, exploring novel metformin-based compounds and drug delivery systems, including derivatives targeting mitochondria, combination therapies, and novel nanoformulations, showing enhanced anticancer effects.