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Clin Transl Gastroenterol. 2019 Nov 11. doi: 10.14309/ctg.0000000000000092. [Epub ahead of print]

Metformin Is Associated With Reduced Odds for Colorectal Cancer Among Persons With Diabetes.

Author information

1
Department of Medicine, University of California, San Diego, La Jolla, California, USA.
2
Moores Cancer Center, La Jolla, California, USA.
3
University of Colorado School of Medicine, Denver, Colorado, USA.
4
Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA.
5
Department of Research, VA San Diego Healthcare System, San Diego, California, USA.
6
Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, California, USA.
7
Department of Medicine, VA San Diego Healthcare System, San Diego, California, USA.
8
Department of Pharmacology, University of California, San Diego, La Jolla, California, USA.
9
VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
10
University of Utah, Salt Lake City, Utah, USA.
11
VA San Francisco Healthcare System, San Francisco, California, USA.
12
University of California, San Francisco, San Francisco, California, USA.

Abstract

INTRODUCTION:

Metformin may be associated with reduced colorectal cancer (CRC) risk, but findings from previous studies have been inconsistent and had insufficient sample sizes to examine whether the association differs by anatomic site. This study examined whether metformin was associated with reduced CRC risk, both overall and stratified by anatomic site, in a large sample of persons with diabetes who underwent colonoscopy.

METHODS:

We performed a case-control study of US Veterans with prevalent diabetes who underwent colonoscopy between 1999 and 2014 using Department of Veterans Affairs electronic health record data. Cases were defined by presence of CRC at colonoscopy, while controls had normal colonoscopy. The primary exposure was metformin use at time of colonoscopy (yes/no). Association of metformin exposure with CRC (further stratified by proximal, distal, or rectal subsite) was examined using multivariable and multinomial logistic regression and summarized by odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS:

We included 6,650 CRC patients and 454,507 normal colonoscopy patients. CRC cases were older and had lower metformin exposure. Metformin was associated with 8% relative reduction in CRC odds (OR: 0.92, 95% CI: 0.87-0.96). By subsite, metformin was associated with a 14% statistically significant reduced rectal cancer odds (OR: 0.86, 95% CI: 0.78-0.94) but no reduced distal or proximal cancer odds.

DISCUSSION:

Metformin was associated with reduced CRC odds-particularly rectal cancer-in a large sample of persons with diabetes undergoing colonoscopy.

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