背景:二甲双胍,用于管理高血糖,与糖尿病患者的结直肠癌(CRC)风险降低有关。然而,非西班牙裔黑人和社会经济地位较低的人缺乏证据,谁面临糖尿病和CRC的风险升高。在这项研究中,我们在南方社区队列研究(SCCS)中调查了二甲双胍使用与CRC事件风险之间的关系,种族和SES多样化的前瞻性队列。
方法:参与者报告了他们的糖尿病诊断和药物治疗,包括二甲双胍,在入学(2002-2009年)和大约每五年的跟踪调查期间。通过州癌症登记处和国家死亡指数确定了CRC的事件病例。采用比例风险模型探讨二甲双胍使用与CRC风险之间的关系。调整癌症风险因素。
结果:共有25,992名糖尿病患者被纳入分析,其中10095人服用二甲双胍。在这些参与者中,76%的人被认定为非西班牙裔黑人,60%的家庭收入低于15,000美元/年。二甲双胍的使用与CRC风险显著降低相关(HR[95%CI]:0.71[0.55-0.93]),结肠癌(0.80[0.59-1.07])和直肠癌(0.49[0.28-0.86])的结果一致。与非西班牙裔黑人参与者(0.80[0.59-1.08]相比,非西班牙裔白人个体的保护性关联似乎更强(0.51[0.31-0.85]),p相互作用=.13)。此外,在肥胖个体中观察到保护性关联(BMI≥30kg/m2,0.59[0.43-0.82],但在非肥胖参与者中未观察到(0.99[0.65-1.51],p-interaction=.05)结论:我们的发现表明二甲双胍的使用与糖尿病患者的CRC风险降低相关,包括那些主要来自低SES背景的人。这些结果支持以前的流行病学发现,并证明二甲双胍与CRC相关的保护性关联可能在潜在风险较高的人群中推广。
BACKGROUND: Metformin, utilized to manage hyperglycemia, has been linked to a reduced risk of colorectal cancer (CRC) among individuals with diabetes. However, evidence is lacking for non-Hispanic Black individuals and those with lower socioeconomic status (SES), who face elevated risk for both diabetes and CRC. In this
study, we investigated the association between metformin use and incident CRC risk within the Southern Community Cohort
Study (SCCS), a racially- and SES-diverse prospective cohort.
METHODS: Participants reported their diabetes diagnosis and medications, including metformin, upon enrollment (2002-2009) and during follow-up surveys approximately every five years. Incident cases of CRC were identified through state cancer registries and the National Death Index. Proportional hazards models were employed to explore the relationship between metformin use and CRC risk, adjusted for cancer risk factors.
RESULTS: A total of 25,992 participants with diabetes were included in the analysis, among whom 10,095 were taking metformin. Of these participants, 76% identified as non-Hispanic Black, and 60% reported household incomes <$15,000/year. Metformin use was associated with a significantly lower CRC risk (HR [95% CI]: 0.71 [0.55-0.93]), with consistent results for both colon (0.80 [0.59-1.07]) and rectal cancers (0.49 [0.28-0.86]). The protective association appeared to be stronger among non-Hispanic White individuals (0.51 [0.31-0.85]) compared to non-Hispanic Black participants (0.80 [0.59-1.08], p-interaction =.13). Additionally, a protective association was observed among obese individuals (BMI ≥30 kg/m2, 0.59 [0.43-0.82] but not among non-obese participants (0.99 [0.65-1.51], p-interaction =.05) CONCLUSION: Our findings indicate that metformin use is associated with a reduced risk of CRC in individuals with diabetes, including among those from predominantly low SES backgrounds. These results support previous epidemiological findings, and demonstrate that the protective association for metformin in relation to incident CRC likely generalizes to populations with higher underlying risk.