TY - JOUR

T1 - The impact of surgery and oncological treatment on risk of type 2 diabetes onset in patients with colorectal cancer

T2 - nationwide cohort study in Denmark

AU - Krag, Caroline

AU - Svane, Maria Saur

AU - Madsbad, Sten

AU - Graversen, Susanne Boel

AU - Christensen, Jesper Frank

AU - Sørensen, Thorkild I A

AU - Lehrskov, Louise Lang

AU - Laurberg, Tinne

N1 - © 2023, Krag, Svane et al.

PY - 2024

Y1 - 2024

N2 - BACKGROUND: Comorbidity with type 2 diabetes (T2D) results in worsening of cancer-specific and overall prognosis in colorectal cancer (CRC) patients. The treatment of CRC per se may be diabetogenic. We assessed the impact of different types of surgical cancer resections and oncological treatment on risk of T2D development in CRC patients.METHODS: We developed a population-based cohort study including all Danish CRC patients, who had undergone CRC surgery between 2001 and 2018. Using nationwide register data, we identified and followed patients from date of surgery and until new onset of T2D, death, or end of follow-up.RESULTS: In total, 46,373 CRC patients were included and divided into six groups according to type of surgical resection: 10,566 Right-No-Chemo (23%), 4645 Right-Chemo (10%), 10,151 Left-No-Chemo (22%), 5257 Left-Chemo (11%), 9618 Rectal-No-Chemo (21%), and 6136 Rectal-Chemo (13%). During 245,466 person-years of follow-up, 2556 patients developed T2D. The incidence rate (IR) of T2D was highest in the Left-Chemo group 11.3 (95% CI: 10.4-12.2) per 1000 person-years and lowest in the Rectal-No-Chemo group 9.6 (95% CI: 8.8-10.4). Between-group unadjusted hazard ratio (HR) of developing T2D was similar and non-significant. In the adjusted analysis, Rectal-No-Chemo was associated with lower T2D risk (HR 0.86 [95% CI 0.75-0.98]) compared to Right-No-Chemo.For all six groups, an increased level of body mass index (BMI) resulted in a nearly twofold increased risk of developing T2D.CONCLUSIONS: This study suggests that postoperative T2D screening should be prioritised in CRC survivors with overweight/obesity regardless of type of CRC treatment applied.FUNDING: The Novo Nordisk Foundation (NNF17SA0031406); TrygFonden (101390; 20045; 125132).

AB - BACKGROUND: Comorbidity with type 2 diabetes (T2D) results in worsening of cancer-specific and overall prognosis in colorectal cancer (CRC) patients. The treatment of CRC per se may be diabetogenic. We assessed the impact of different types of surgical cancer resections and oncological treatment on risk of T2D development in CRC patients.METHODS: We developed a population-based cohort study including all Danish CRC patients, who had undergone CRC surgery between 2001 and 2018. Using nationwide register data, we identified and followed patients from date of surgery and until new onset of T2D, death, or end of follow-up.RESULTS: In total, 46,373 CRC patients were included and divided into six groups according to type of surgical resection: 10,566 Right-No-Chemo (23%), 4645 Right-Chemo (10%), 10,151 Left-No-Chemo (22%), 5257 Left-Chemo (11%), 9618 Rectal-No-Chemo (21%), and 6136 Rectal-Chemo (13%). During 245,466 person-years of follow-up, 2556 patients developed T2D. The incidence rate (IR) of T2D was highest in the Left-Chemo group 11.3 (95% CI: 10.4-12.2) per 1000 person-years and lowest in the Rectal-No-Chemo group 9.6 (95% CI: 8.8-10.4). Between-group unadjusted hazard ratio (HR) of developing T2D was similar and non-significant. In the adjusted analysis, Rectal-No-Chemo was associated with lower T2D risk (HR 0.86 [95% CI 0.75-0.98]) compared to Right-No-Chemo.For all six groups, an increased level of body mass index (BMI) resulted in a nearly twofold increased risk of developing T2D.CONCLUSIONS: This study suggests that postoperative T2D screening should be prioritised in CRC survivors with overweight/obesity regardless of type of CRC treatment applied.FUNDING: The Novo Nordisk Foundation (NNF17SA0031406); TrygFonden (101390; 20045; 125132).

KW - Humans

KW - Diabetes Mellitus, Type 2/complications

KW - Denmark/epidemiology

KW - Colorectal Neoplasms/epidemiology

KW - Male

KW - Female

KW - Aged

KW - Middle Aged

KW - Cohort Studies

KW - Risk Factors

KW - Incidence

KW - Aged, 80 and over

KW - Adult

KW - Registries

U2 - 10.7554/eLife.89354

DO - 10.7554/eLife.89354

M3 - Journal article

C2 - 38829205

VL - 12

JO - eLife

JF - eLife

SN - 2050-084X

M1 - RP89354

ER -