Colorectal Cancer and Subsequent Diabetes Risk: A Population-based Cohort Study in Taiwan

Hsin-Yin Hsu; Yih-Jong Chern; Min-Shu Hsu; Tzu-Lin Yeh; Ming-Chieh Tsai; Jing-Rong Jhuang; Cheng-Tzu Hsieh; Chun-Ju Chiang; Wen-Chung Lee; Lee-Ching Hwang; Kuo-Liong Chien

doi:10.1210/clinem/dgae257

Colorectal Cancer and Subsequent Diabetes Risk: A Population-based Cohort Study in Taiwan

J Clin Endocrinol Metab. 2024 Apr 25:dgae257. doi: 10.1210/clinem/dgae257. Online ahead of print.

Authors

Hsin-Yin Hsu^{1

2

3}, Yih-Jong Chern⁴, Min-Shu Hsu⁵, Tzu-Lin Yeh^{3

6}, Ming-Chieh Tsai^{2

3

7}, Jing-Rong Jhuang⁸, Cheng-Tzu Hsieh⁹, Chun-Ju Chiang^{2

10}, Wen-Chung Lee^{2

10}, Lee-Ching Hwang^{1

3}, Kuo-Liong Chien^{2

11

12}

Affiliations

¹ Department of Family Medicine, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, Taiwan.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei City, Taiwan.
³ Department of Medicine, MacKay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, Taiwan.
⁴ Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan.
⁵ Department of Medical Research, Mackay Memorial Hospital, No. 45, Minsheng Rd., Tamsui District, New Taipei City, Taiwan.
⁶ Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Rd, East District, Hsinchu City, Taiwan.
⁷ Division of Endocrinology, Department of Internal Medicine, MacKay Memorial Hospital, Tamsui Branch, No. 45, Minsheng Rd., Tamsui District, New Taipei City, Taiwan.
⁸ Institute of Statistical Science, Academia Sinica, No. 128, Academia Rd, Section 2, Nangang District, Taipei City, Taiwan.
⁹ Department of Epidemiology, University of California, 650 Charles E. Young Dr. South 16-035 Center for Health Sciences Los Angeles CA 90095-1772, USA.
¹⁰ Taiwan Cancer Registry, No. 17, Xu-Zhou Rd., Taipei City, Taiwan.
¹¹ Population Health Research Center, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei City, Taiwan.
¹² Department of Internal Medicine, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist., Taipei City, Taiwan.

PMID: 38661006
DOI: 10.1210/clinem/dgae257

Abstract

Context: The association between colorectal cancer (CRC) and new-onset diabetes mellitus remains unclear.

Objective: To examine the association between CRC and the risk of subsequent diabetes mellitus and to further investigate the impact of chemotherapy on diabetes mellitus risk in CRC.

Design: A nationwide cohort study.

Methods: Using the Taiwan Cancer Registry Database (2007-2018) linked with health databases, 86,268 patients with CRC and an equal propensity score-matched cohort from the general population were enrolled. Among them, 37,277 CRC patients from the Taiwan Cancer Registry (2007-2016) were analyzed for diabetes mellitus risk associated with chemotherapy. Chemotherapy exposure within 3 years of diagnosis was categorized as no chemotherapy, <90 days, 90-180 days, and >180 days. Differences in diabetes mellitus risk were assessed across these categories.

Results: Each group involved 86,268 participants after propensity score matching. The patients with CRC had a 14% higher risk of developing diabetes mellitus than the matched general population (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.09-1.20). The highest risk was observed within the first year after diagnosis followed by a sustained elevated risk. Long-term chemotherapy (>180 days within 3 years) was associated with a 60-70% increased risk of subsequent diabetes mellitus (HR: 1.64, 95% CI: 1.07-2.49).

Conclusion: Patients with CRC are associated with an elevated risk of diabetes mellitus, and long-term chemotherapy, particularly involving capecitabine, increases diabetes mellitus risk. Thus, monitoring blood glucose levels is crucial for patients with CRC, especially during extended chemotherapy.

Keywords: cancer chemotherapy; capecitabine; colorectal cancer; diabetes mellitus; integrated medicine.

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