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©The Author(s) 2021.
World J Clin Cases. Apr 16, 2021; 9(11): 2433-2445
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2433
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2433
Table 1 Glycemic status in the type 2 diabetes mellitus, nondiabetic, prediabetic and control groups at an urban public hospital
| T2DM, n = 529 | NoDM, n = 1077 | Pre-DM, n = 542 | Control, n = 452 | |
| HbA1c (%) median ± IQR | 7.2 ± 1.9 | 5.7 ± 0.6 | 5.9 ± 0.3 | 5.4 ± 0.3 |
| Fasting blood sugar (mmoL/L) median ± IQR | 6.9 ± 3.4 | N/A | N/A | N/A |
Table 2 Anti-diabetic medications in type 2 diabetes mellitus patients at an urban public hospital
| Anti-diabetes medications | No. of T2DM subjects (%) n = 529 |
| None | 114 (21.6) |
| Insulin | 129 (24.4) |
| Metformin | 359 (67.9) |
| Sulfonylureas | 145 (27.4) |
| DPP4 inhibitors | 158 (29.9) |
| Thiazolidinediones | 2 (0.4) |
| GLP1 agonists | 3 (0.6) |
| SGLT-2 inhibitors | 0 (0.0) |
| Meglitinides | 1 (0.2) |
| Acarbose | 2 (0.4) |
Table 3 Comparison of patient characteristics between type 2 diabetes mellitus and nondiabetic patients at an urban public hospital
| Variables | T2DM, n = 529 | NoDM, n = 1077 | P value |
| Age (yr) median ± IQR | 58 ± 11 | 55 ± 10 | < 0.0001 |
| Male sex, n (%) | 189 (35.7) | 379 (35.2) | 0.8627 |
| Race, n (%) | 0.8741 | ||
| Black/AA | 493 (93.2) | 995 (92.4) | |
| Non-Hispanic White/EA | 2 (0.4) | 3 (0.3) | |
| Asian | 2 (0.4) | 6 (0.6) | |
| Other | 32 (6.0) | 73 (6.8) | |
| Hispanic ethnicity, n (%) | 26 (5.6) | 43 (4.5) | 0.4329 |
| BMI (kg/m2), median ± IQR | 29.5 ± 7.5 | 28.3 ± 7.5 | < 0.0001 |
| Smoking, n (%) | 0.0494 | ||
| Current | 20 (3.9) | 75 (7.1) | |
| Past | 20 (3.9) | 39 (3.7) | |
| Never | 471 (92.2) | 946 (89.2) | |
| Aspirin use, n (%) | 135 (25.5) | 130 (12.1) | < 0.0001 |
| HIV status, n (%) | 26 (4.9) | 64 (5.9) | 0.4245 |
| Fellow participation, n (%) | 119 (22.5) | 263 (24.4) | 0.4125 |
| Quality of colonoscopic prep | 0.3346 | ||
| Good | 511 (96.6) | 1050 (97.5) | |
| Fair | 18 (3.4) | 27 (2.5) | |
| Insurance, n (%) | 0.2072 | ||
| Commercial | 85 (16.1) | 180 (16.7) | |
| Medicare | 20 (3.8) | 23 (2.1) | |
| Medicaid | 326 (61.6) | 652 (60.5) | |
| Self-pay | 98 (18.5) | 222 (20.6) |
Table 4 Comparison of colonic lesions (polyps and colorectal cancer) in type 2 diabetes mellitus and nondiabetic patients at an urban public hospital, n (%)
| Variables | T2DM, n = 529 | NoDM, n = 1077 | P value |
| All colonic neoplastic lesions | 195 (36.9) | 338 (31.4) | 0.0322 |
| Location of neoplastic lesions | 0.1688 | ||
| Left-sided only | 56 (10.6) | 103 (9.6) | |
| Right-sided only | 105 (19.8) | 179 (16.6) | |
| Both | 34 (6.4) | 56 (5.2) | |
| Adenomas (not serrated or CRC) | 186 (35.2) | 327 (30.4) | 0.0581 |
| Sessile serrated adenoma | 6 (1.1) | 7 (0.6) | 0.3769 |
| Advanced adenoma (> 1 cm, villous, high grade dysplasia, not including CRC) | 29 (5.5) | 38 (3.5) | 0.0887 |
| High risk adenoma (> 3 adenomas and/or advanced adenoma) | 45 (8.5) | 75 (7.0) | 0.3131 |
| CRC | 3 (0.6) | 4 (0.4) | 0.6923 |
| Hyperplastic polyp only (no additional colonic neoplasia) | 66 (12.5) | 136 (12.6) | 0.9347 |
Table 5 Comparison of colonic lesions (polyps and colorectal cancer) in type 2 diabetes mellitus and control patients (hemoglobin A1c < 5.7%) at an urban public hospital, n (%)
| Variables | T2DM, n = 529 | Control, n = 452 | P value |
| All colonic neoplastic lesions | 195 (36.9) | 131 (29.0) | 0.0092 |
| Location of neoplastic lesions | 0.0359 | ||
| Left-sided only | 56 (10.6) | 47 (10.4) | |
| Right-sided only | 105 (19.8) | 63 (13.9) | |
| Both | 34 (6.4) | 21 (4.6) | |
| Adenomas (not serrated or CRC) | 186 (35.2) | 126 (27.9) | 0.0166 |
| Sessile serrated adenoma | 6 (1.1) | 3 (0.7) | 0.5098 |
| Advanced adenoma (> 1 cm, villous, high grade dysplasia, not including CRC) | 29 (5.5) | 13 (2.9) | 0.0534 |
| High risk adenoma (> 3 adenomas and/or advanced adenoma) | 45 (8.5) | 29 (6.4) | 0.2275 |
| CRC | 3 (0.6) | 2 (0.4) | 1.0000 |
| Hyperplastic polyp only (no additional colonic neoplasia) | 66 (12.5) | 59 (13.1) | 0.8499 |
Table 6 Comparison of colonic lesions (polyps and colorectal cancer) in prediabetic diabetes mellitus (hemoglobin A1c ≥ 5.7%, < 6.5%) and control patients (hemoglobin A1c < 5.7%) at an urban public hospital, n (%)
| Variables | Pre-DM n = 542 | Control n = 452 | P value |
| All colonic neoplastic lesions | 173 (31.9) | 131 (29.0) | 0.3310 |
| Location of neoplastic lesions | 0.5944 | ||
| Left-sided only | 54 (10.0) | 47 (10.4) | |
| Right-sided only | 92 (17.0) | 63 (13.9) | |
| Both | 27 (5.0) | 21 (4.6) | |
| Adenomas (not serrated or CRC) | 168 (31.0) | 126 (27.9) | 0.2916 |
| Sessile serrated adenoma | 3 (0.6) | 3 (0.7) | 1.0000 |
| Advanced adenoma (> 1 cm, villous, high grade dysplasia, not including CRC) | 22 (4.1) | 13 (2.9) | 0.3894 |
| High risk adenoma (> 3 adenomas and/or advanced adenoma) | 39 (7.2) | 29 (6.4) | 0.7058 |
| CRC | 2 (0.4) | 2 (0.4) | 1.0000 |
| Hyperplastic polyp only (no additional colonic neoplasia) | 68 (12.5) | 59 (13.1) | 0.8463 |
Table 7 Comparison of colonic lesions (polyps and colorectal cancer) in type 2 diabetes mellitus and prediabetics mellitus (hemoglobin A1c ≥ 5.7%, < 6.5%) patients at an urban public hospital, n (%)
| Variables | T2DM n = 529 | Pre-DM n = 542 | P value |
| All colonic neoplastic lesions | 195 (36.9) | 173 (31.9) | 0.0959 |
| Location of neoplastic lesions | 0.3534 | ||
| Left-sided only | 56 (10.6) | 54 (10.0) | |
| Right-sided only | 105 (19.8) | 92 (17.0) | |
| Both | 34 (6.4) | 27 (5.0) | |
| Adenomas (not serrated or CRC) | 186 (35.2) | 168 (31.0) | 0.1515 |
| Sessile serrated adenoma | 6 (1.1) | 3 (0.6) | 0.3324 |
| Advanced adenoma (> 1 cm, villous, high grade dysplasia, not including CRC) | 29 (5.5) | 22 (4.1) | 0.3137 |
| High risk adenoma (> 3 adenomas and/or advanced adenoma) | 45 (8.5) | 39 (7.2) | 0.4321 |
| CRC | 3 (0.6) | 2 (0.4) | 0.6858 |
| Hyperplastic polyp only (no additional colonic neoplasia) | 66 (12.5) | 68 (12.5) | 1.0000 |
Table 8 Characteristics of patients with adenomas vs patients with no neoplasia detected on index screening colonoscopy from two disparate populations, n (%)
| Factors | Missing | Level | No neoplasia, n = 3138 (70.95%) | Adenoma, n = 1285 (29.05%) | P value |
| T2DM | 0 | Yes | 501 (62.5) | 300 (37.5) | < 0.0001 |
| No | 2637 (72.8) | 985 (27.2) | |||
| Age (yr) | 0 | 54.0 ± 8.9 | 57.0 ± 10.6 | < 0.0001 | |
| BMI (kg/m²) | 3 | 27.8 ± 7.0 | 28.5 ± 7.3 | 0.0004 | |
| Sex | 0 | Female | 1953 (76.1) | 612 (23.9) | < 0.0001 |
| Male | 1185 (63.8) | 673 (36.2) | |||
| Race | 0 | White | 1797 (72.7) | 674 (27.3) | 0.9310 |
| Black | 1124 (68.6) | 515 (31.4) | |||
| Asian | 67 (71.3) | 27 (28.7) | |||
| Other | 150 (68.5) | 69 (31.5) | |||
| Smoking | 35 | Never | 2206 (72.2) | 850 (27.8) | < 0.0001 |
| Past | 602 (69.8) | 260 (30.2) | |||
| Current | 305 (64.9) | 165 (35.1) | |||
| Insurance | 0 | Commercial | 1673 (74.2) | 583 (25.8) | 0.0034 |
| Medicare | 219 (66.4) | 111 (33.6) | |||
| Medicaid | 986 (67.6) | 473 (32.4) | |||
| Self-Pay | 260 (68.8) | 118 (31.2) | |||
| Fellow participation | 0 | Yes | 605 (67.4) | 293 (32.6) | 0.2729 |
| No | 2533 (71.9) | 992 (28.1) | |||
| Aspirin use | 9 | Yes | 405 (65.5) | 213 (34.5) | 0.0038 |
| No | 2727 (71.8) | 1069 (28.2) |
Table 9 Estimated odds ratios and 95% confidence intervals of the risk factors for adenoma detection rate based on a multivariable generalized linear mixed model
| Factors | Levels | OR with 95%CI | P value |
| T2DM | T2DM vs NoDM | 1.29 (1.08-1.55) | 0.0049 |
| Age (yr) | Every 1 year increase in age | 1.05 (1.04-1.06) | < 0.0001 |
| BMI kg/m² | Every 1 unit increase in BMI | 1.02 (1.01-1.03) | 0.0003 |
| Sex | Male vs Female | 1.87 (1.62-2.15) | < 0.0001 |
| Race | Black vs White | 0.93 (0.69-1.24) | 0.8020 |
| Asian vs White | 1.19 (0.74-1.91) | ||
| Other vs White | 1.02 (0.72-1.44) | ||
| Insurance | Medicare vs Commercial | 0.9 (0.68 -1.18) | 0.0582 |
| Medicaid vs Commercial | 1.25 (1.04-1.5) | ||
| Self-pay vs Commercial | 1.1 (0.83-1.45) | ||
| Aspirin use | Yes vs No | 0.97 (0.80-1.18) | 0.7966 |
| Smoking | Current vs Past | 1.32 (1.02-1.70) | 0.0026 |
| Current vs Never | 1.47 (1.18-1.82) |
- Citation: Joseph DF, Li E, Stanley III SL, Zhu YC, Li XN, Yang J, Ottaviano LF, Bucobo JC, Buscaglia JM, Miller JD, Veluvolu R, Follen M, Grossman EB. Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations. World J Clin Cases 2021; 9(11): 2433-2445
- URL: https://www.wjgnet.com/2307-8960/full/v9/i11/2433.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v9.i11.2433