Diabetes but not insulin is associated with higher colon cancer mortality

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Aug 21, 2012; 18(31): 4182-4190
Published online Aug 21, 2012. doi: 10.3748/wjg.v18.i31.4182

Table 1 Age/sex-specific mortality rates (per 100 000 person-years) for colon cancer in diabetic patients and their mortality rate ratios compared to the average mortality rates in the general population of Taiwan

Age (yr)	Men					Women
	n	N	PY	MR	MRR (95% CI)	n	N	PY	MR	MRR (95% CI)
Original diabetic cohort
Followed from enrollment to the end of 2006
25-54	76	42107	363948.2	20.88	5.69 (4.65, 6.96)^a	43	43749	399556.9	10.76	3.05 (2.29, 4.06)^a
55-64	158	28867	225706.1	70.00	2.75 (2.36, 3.21)^a	146	37317	314033.6	46.49	2.67 (2.27, 3.14)^a
65-74	265	30704	211811.1	125.11	2.01 (1.78, 2.27)^a	238	35194	258155.6	92.19	2.09 (1.84, 2.38)^a
≥ 75	142	11669	59761.6	237.61	1.65 (1.40, 1.95)^a	146	15313	83905.5	174.01	1.46 (1.24, 1.72)^a
Followed from enrollment to the end of 2000
25-54	23	42107	143238.6	16.06	4.38 (3.00, 6.37)^a	16	43749	153584.7	10.42	2.95 (1.84, 4.71)^a
55-64	52	28867	96078	54.12	2.12 (1.62, 2.78)^a	55	37317	129321.2	42.53	2.44 (1.88, 3.17)^a
65-74	112	30704	94488.8	118.53	1.90 (1.58, 2.29)^a	91	35194	113687.6	80.04	1.81 (1.48, 2.23)^a
≥ 75	70	11669	30353.6	230.61	1.60 (1.27, 2.03)^a	75	15313	42092.9	178.18	1.49 (1.19, 1.87)^a
Followed from 2001 to the end of 2006
25-54	30	32626	186021.3	16.13	4.39 (3.16, 6.11)^a	22	34400	201514.2	10.92	3.09 (2.07, 4.60)^a
55-64	68	22743	122446.4	55.53	2.18 (1.72, 2.76)^a	52	29880	167205.9	31.10	1.79 (1.36, 2.34)^a
65-74	172	26548	133463.8	128.87	2.07 (1.78, 2.40)^a	131	33591	176023.3	74.42	1.69 (1.42, 2.00)^a
≥ 75	114	13653	59608.3	191.25	1.33 (1.11, 1.60)^a	131	17808	79994.6	163.76	1.37 (1.16, 1.63)^a
Sub-cohort diabetic patients
Diabetes of any duration at enrollment
25-54	25	13837	100793.2	24.80	6.76 (4.81, 9.50)^a	16	12768	95960.8	16.67	4.72 (3.02, 7.37)^a
55-64	62	12454	84551.8	73.33	2.88 (2.26, 3.66)^a	53	16717	118278.5	44.81	2.57 (1.98, 3.35)^a
65-74	99	12395	76349.6	129.67	2.08 (1.71, 2.53)^a	86	15029	96058.4	89.53	2.03 (1.64, 2.50)^a
≥ 75	42	3574	17710.4	237.15	1.65 (1.22, 2.23)^a	43	4891	25384.8	169.39	1.42 (1.05, 1.91)^a
Diabetes duration < 10 yr at enrollment
25-54	15	11631	86016.8	17.44	4.75 (3.00, 7.53)^a	12	10389	78983.7	15.19	4.30 (2.56, 7.23)^a
55-64	42	8892	61949.1	67.80	2.66 (1.99, 3.57)^a	37	11636	84435.4	43.82	2.52 (1.84, 3.45)^a
65-74	62	7887	49825.0	124.44	2.00 (1.56, 2.55)^a	47	9246	61226.8	76.76	1.74 (1.31, 2.31)^a
≥ 75	29	2138	10946.7	264.92	1.84 (1.29, 2.64)^a	23	2814	15302.6	150.30	1.26 (0.84, 1.90)
Diabetes duration ≥ 10 yr at enrollment
25-54	10	2206	14773	67.69	18.44 (11.81, 28.80)^a	4	2379	16988.5	23.55	6.66 (2.85, 15.56)^a
55-64	20	3562	22608.3	88.46	3.47 (2.30, 5.25)^a	16	5081	33862.5	47.25	2.71 (1.69, 4.35)^a
65-74	37	4508	26541.7	139.40	2.24 (1.63, 3.07)^a	39	5783	34845.7	111.92	2.54 (1.87, 3.44)^a
≥ 75	13	1436	6785.4	191.59	1.33 (0.77, 2.29)	20	2077	10103.5	197.95	1.66 (1.07, 2.56)^a
Sub-cohort type 2 diabetic patients
Diabetes of any duration at enrollment
25-54	23	13239	96635.9	23.80	6.49 (4.54, 9.26)^a	16	12260	92076.3	17.38	4.92 (3.16, 7.66)^a
55-64	60	12082	82183.2	73.01	2.87 (2.24, 3.66)^a	51	16288	115494.5	44.16	2.54 (1.94, 3.32)^a
65-74	92	12051	74413.3	123.63	1.98 (1.62, 2.43)^a	83	14570	93223.1	89.03	2.02 (1.63, 2.50)^a
≥ 75	39	3448	17171.3	227.12	1.58 (1.16, 2.16)^a	43	4756	24716.7	173.97	1.46 (1.08, 1.97)^a
Diabetes duration < 10 yr at enrollment
25-54	14	11248	83333.9	16.80	4.58 (2.84, 7.38)^a	12	10082	76622.8	15.66	4.43 (2.64, 7.44)^a
55-64	40	8730	60901.6	65.68	2.58 (1.91, 3.48)^a	36	11453	83223.4	43.26	2.48 (1.81, 3.42)^a
65-74	59	7742	48999.2	120.41	1.93 (1.50, 2.49)^a	46	9068	60169.4	76.45	1.73 (1.30, 2.31)^a
≥ 75	27	2088	10708.6	252.13	1.75 (1.21, 2.55)^a	23	2760	15063.9	152.68	1.28 (0.85, 1.93)
Diabetes duration ≥ 10 yr at enrollment
25-54	9	1991	13298.7	67.68	18.44 (11.53, 29.50)^a	4	2178	15465.0	25.86	7.32 (3.17, 16.88)^a
55-64	20	3352	21284.3	93.97	3.69 (2.45, 5.56)^a	15	4835	32290.5	46.45	2.67 (1.64, 4.35)^a
65-74	33	4309	25428.1	129.78	2.08 (1.49, 2.91)^a	37	5502	33067.7	111.89	2.53 (1.85, 3.47)^a
≥ 75	12	1360	6484.3	185.06	1.29 (0.73, 2.26)	20	1996	9674.1	206.74	1.73 (1.12, 2.67)^a

^aP < 0.05 vs general population. PY: Person-years; MR: Mortality rate; MRR: Mortality rate ratio; CI: Confidence interval; n: Case number of colon cancer; N: Case number observed.

Table 2 Baseline characteristics of the sub-cohort of diabetic men and women who had been interviewed with a baseline questionnaire

Variable	Men	Women	P value
n	42 260	49 405
Age, yr	59.8 (11.7)	61.5 (10.8)	< 0.0001
Diabetes duration, yr	7.0 (6.6)	7.5 (6.6)	< 0.0001
Diabetes type, % type 1	1440 (3.4)	1531 (3.1)	0.0085
Body mass index, kg/m²	24.4 (3.4)	24.7 (3.8)	< 0.0001
Smoking, % yes	26 522 (62.8)	1703 (3.5)	< 0.0001
Use of insulin, % yes	3717 (8.8)	5059 (10.2)	< 0.0001
Area of residence, % urban	20 231 (47.9)	22 264 (45.1)	< 0.0001
Colon cancer mortality	228 (0.5)	198 (0.4)	0.0021

Data are expressed as mean (SD) or n (%).

Table 3 Cox proportional hazards models showing hazard ratios and 95% confidence intervals for colon cancer mortality in diabetic patients by age before and after exclusion of patients with a duration of < 5 years between onset of diabetes and colon cancer mortality

Variables	Interpretation	Hazard ratio (95% CI)
		Age≥25 yr				Age 25-64 yr		Age≥65 yr
		Unadjusted	P value	Mutually adjusted	P value	Mutually adjusted	P value	Mutually-adjusted	P value
Before exclusion
Age	Every 1-yr increment	1.077 (1.066-1.088)	< 0.0001	1.077 (1.066-1.088)	< 0.0001	1.090 (1.062-1.119)	< 0.0001	1.072 (1.049-1.096)	< 0.0001
Sex	Men vs women	1.395 (1.150-1.691)	0.0007	1.256 (0.976-1.618)	0.0769	1.181 (0.758-1.841)	0.4622	1.288 (0.946-1.753)	0.1081
Diabetes duration	Every 1-yr increment	1.032 (1.019-1.045)	< 0.0001	1.006 (0.992-1.020)	0.3845	0.993 (0.964-1.023)	0.6652	1.009 (0.994-1.025)	0.2329
Diabetes type	Type 2 vs type 1	0.682 (0.430-1.081)	0.1036	0.750 (0.432-1.301)	0.3057	0.914 (0.345-2.425)	0.8574	0.680 (0.348-1.328)	0.2588
Body mass index	Every 1-kg/m² increment	0.956 (0.929-0.984)	0.0021	0.976 (0.948-1.005)	0.1062	0.966 (0.920-1.014)	0.1616	0.981 (0.946-1.018)	0.3080
Smoking	Yes vs no	1.484 (1.219-1.808)	< 0.0001	1.384 (1.068-1.792)	0.0140	1.746 (1.121-2.720)	0.0136	1.215 (0.881-1.676)	0.2351
Insulin use	Yes vs no	1.344 (0.992-1.821)	0.0564	1.235 (0.843-1.809)	0.2782	1.318 (0.686-2.532)	0.4076	1.215 (0.759-1.946)	0.4168
Area of residence	Urban vs rural	0.901 (0.743-1.094)	0.2928	0.852 (0.702-1.034)	0.1046	0.734 (0.530-1.016)	0.0621	0.931 (0.731-1.187)	0.5660
After exclusion
Age	Every 1-yr increment	1.082 (1.070-1.094)	< 0.0001	1.080 (1.068-1.092)	< 0.0001	1.096 (1.064-1.128)	< 0.0001	1.070 (1.046-1.095)	< 0.0001
Sex	Men vs women	1.454 (1.186-1.784)	0.0003	1.281 (0.980-1.676)	0.0704	1.355 (0.836-2.195)	0.2172	1.249 (0.903-1.728)	0.1787
Diabetes duration	Every 1-yr increment	1.046 (1.034-1.059)	< 0.0001	1.021 (1.007-1.034)	0.0022	1.025 (0.996-1.054)	0.0883	1.020 (1.004-1.035)	0.0120
Diabetes type	Type 2 vs type 1	0.640 (0.398-1.028)	0.0647	0.710 (0.402-1.254)	0.2386	0.637 (0.229-1.771)	0.3878	0.737 (0.371-1.465)	0.3837
Body mass index	Every 1-kg/m² increment	0.960 (0.932-0.989)	0.0078	0.984 (0.955-1.015)	0.3034	0.983 (0.933-1.035)	0.5160	0.984 (0.948-1.022)	0.4153
Smoking	Yes vs no	1.555 (1.263-1.914)	< 0.0001	1.445 (1.099-1.899)	0.0083	1.814 (1.130-2.913)	0.0137	1.268 (0.905-1.778)	0.1672
Insulin use	Yes vs no	1.431 (1.044-1.961)	0.0258	1.159 (0.781-1.722)	0.4639	0.927 (0.440-1.954)	0.8419	1.274 (0.798-2.035)	0.3106
Area of residence	Urban vs rural	0.909 (0.741-1.116)	0.3639	0.848 (0.691-1.041)	0.1158	0.815 (0.573-1.158)	0.2536	0.876 (0.680-1.128)	0.3040

CI: Confidence interval.

Table 4 Cox proportional hazards models for mortality from colon cancer by duration of insulin use (reference group: diabetic patients not using insulin) before and after exclusion of patients with a duration of < 5 years between onset of diabetes and colon cancer mortality

	Duration of insulin use
Variables adjusted	<5 yr			5-9 yr			≥10 yr
	HR	95% CI	P value	HR	95% CI	P value	HR	95% CI	P value
Before exclusion
Unadjusted	1.128	0.734-1.735	0.5824	1.245	0.664-2.333	0.4947	1.539	0.918-2.579	0.1018
Age	1.388	0.902-2.136	0.1355	1.487	0.793-2.787	0.2163	1.441	0.860-2.416	0.1654
Sex	1.146	0.745-1.763	0.5339	1.267	0.676-2.375	0.4605	1.562	0.932-2.618	0.0907
Diabetes type	1.101	0.682-1.777	0.6931	0.817	0.362-1.843	0.6259	1.321	0.589-2.964	0.4991
Diabetes duration	1.009	0.655-1.556	0.9663	1.028	0.546-1.935	0.9330	1.018	0.590-1.756	0.9491
Body mass index	1.089	0.707-1.675	0.6995	1.210	0.645-2.268	0.5530	1.505	0.898-2.523	0.1208
Smoking	1.143	0.743-1.759	0.5416	1.263	0.674-2.367	0.4666	1.549	0.924-2.596	0.0966
Area of residence	1.122	0.729-1.726	0.6005	1.237	0.660-2.318	0.5074	1.538	0.918-2.578	0.1023
Full model¹	1.217	0.764-1.937	0.4082	0.943	0.442-2.010	0.8788	1.003	0.454-2.212	0.9948
After exclusion
Unadjusted	1.108	0.698-1.761	0.6630	1.416	0.755-2.656	0.2782	1.746	1.041-2.931	0.0348
Age	1.384	0.871-2.199	0.1696	1.704	0.908-3.197	0.0971	1.633	0.973-2.740	0.0635
Sex	1.129	0.710-1.793	0.6085	1.445	0.771-2.711	0.2510	1.776	1.058-2.981	0.0297
Diabetes type	1.089	0.651-1.821	0.7447	1.010	0.446-2.287	0.9807	1.700	0.770-3.757	0.1893
Diabetes duration	0.943	0.592-1.501	0.8045	1.079	0.573-2.034	0.8133	0.968	0.561-1.669	0.9057
Body mass index	1.072	0.674-1.703	0.7702	1.375	0.733-2.581	0.3215	1.710	1.019-2.870	0.0424
Smoking	1.126	0.708-1.788	0.6164	1.440	0.768-2.701	0.2557	1.760	1.049-2.954	0.0323
Area of residence	1.103	0.694-1.752	0.6786	1.409	0.751-2.643	0.2855	1.746	1.040-2.929	0.0349
Full model¹	1.133	0.691-1.857	0.6214	1.038	0.491-2.195	0.9221	1.003	0.462-2.178	0.9949

¹Adjusted for age, sex, diabetes type, diabetes duration, body mass index, smoking and area of residence. HR: Hazard ratio; CI: Confidence interval.

Citation: Tseng CH. Diabetes but not insulin is associated with higher colon cancer mortality. World J Gastroenterol 2012; 18(31): 4182-4190
URL: https://www.wjgnet.com/1007-9327/full/v18/i31/4182.htm
DOI: https://dx.doi.org/10.3748/wjg.v18.i31.4182