The impact of colectomy and chemotherapy on risk of type 2 diabetes onset in patients with colorectal cancer: Nationwide cohort study in Denmark

Author:

Krag Caroline Elisabeth12,Svane Maria Saur13,Madsbad Sten1,Graversen Susanne Boel4,Christensen Jesper Frank567,Sørensen Thorkild IA8,Lehrskov Louise Lang5,Laurberg Tinne4

Affiliation:

1. Department of Endocrinology, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark

2. Department of Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark

3. Department of Surgical Gastroenterology, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark

4. Steno Diabetes Center Aarhus, Aarhus University Hospital, 8200 Aarhus, Denmark

5. Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, 2100 Copenhagen, Denmark

6. Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark

7. Digestive Disease Center, Bispebjerg Hospital, 2400 Copenhagen, Denmark

8. Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, University of Copenhagen, 2200 Copenhagen, Denmark

Abstract

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. We developed a population-based cohort study including all Danish CRC patients, who had undergone CRC surgery between 2001-2018. 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. 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%), 4,645 Right-Chemo (10%), 10,151 Left-No-Chemo (22%), 5,257 Left-Chemo (11%), 9,618 Rectal-No-Chemo (21%) and 6,136 Rectal-Chemo (13%). During 245,466 person-years of follow-up 2,556 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 1,000 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 BMI resulted in a nearly twofold increased risk of developing T2D This study suggests postoperative T2D screening should be prioritized in CRC survivors with overweight/obesity regardless of type of colorectal cancer treatment applied. The Novo Nordisk Foundation (NNF17SA0031406); TrygFonden (101390; 20045; 125132). Colon cancer treatment per se can affect type 2 diabetes risk, but bmi at time of surgery holds the strongest association.

Publisher

eLife Sciences Publications, Ltd

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