| Type2diabetes mellitus (T2DM) and colorectal cancer (CRC)are the two common diseases, which threaten people’s life. An increasing number of studies have found that T2DM may increase the risk of CRC. The mechanism is not clear, In the1950s, some scholars put up with the hypothesis of hyperinsulinemia-CRC. In recent years, other professors present the assumption of Insulin-IGF-1axis, hyperinsulinemia plays an important role in T2DM and CRC. At present, there is little research on hyperinsulinemia in different phases of the T2DM, neither the role which hyperinsulinemia plays in tumorigenesis and progression in CRC patients with T2DM.ObjectivesOur aim was to investigate the trends of CRC and the incidence of CRC with T2DM in Tianjin Union Medicine Center last8years, explore the hyperinsulinemia in different phases of the T2DM and analyze the relationship between hyperinsulinemia and CRC in patients with T2DM. A further aim was to observe the clinical characteristics of the above hypothesis and provide references for future research.Contents and methods:1. Retrospectively analyzed the incidence of CRC and trends of CRC with T2DM in patients hospitalized in Tianjin Union Medicine Center in2005-2012. Compared the clinical data of CRC and CRC with T2DM patients.2. Oral glucose tolerance test and insulin release test were played in different phases of T2DM patients respectively, by which we could find out the characteristics of hyperinsulinemia, and provide clinical reference for further study of hyperinsulinemia-CRC.3. Compared the hyperinsulinemia in CRC with T2DM and T2DM group, as well as the characteristics of tumor in CRC with T2DM and CRC group. To find out the relationship between insulin and IGF-1, and to explore the above hypothesis.Results1.(1) The number of patients with CRC admitted in Tianjin Union Medicine Center in2005-2012increased gradually; and the rate of CRC with T2DM was9.17%, 12.69%,10.61%,12.23%,13.43%,14.38%,15.82%and17.58%. The mean age of CRC with T2DM patients [(66.14±9.19) years], the personage of male patients (66.75%), and the rate of metastasis(53.17%) was apparently higher than of CRC patients [(62.29±11.81) years,58.51%, and44.26%respectively, all P<0.05], while the incidence of rectum cancer decrease (66.09%Vs73.03, P<0.05).(2) Comparison of2009-2012and2005-2008, male patients (62.38%Vs56.12%), CRC with T2DM (15.37%Vs11.22%), the rectal cancer (75.16%Vs68.61%) was higher (P1<0.01), while the tumor in low differentiation decreased (9.53%Vs19.16%, P1<0.01); there was no significantly difference between the two CRC with T2DM group (P2>0.05).2.The insulin secretion delayed, and peak occurred at2hour in all T2DM groups; the hyperinsulinemia patients accounted for50.00%and48.10%in the prediabetes and newly diagnosed group respectively; the hyperinsulinemia made up28.57%,13.89%and10.00%in patients with a diabetes history of0.5to3,4to7and8to11years.3.(1) The percentage of hyperinsulinemia in T2DM with CRC was obvious higher than the T2DM (36.59%Vs21.09%), as well as the patients treated with insulin (34.15%Vs16.33%) and diabetes history>6year (53.66%Vs28.57%), all P1<0.05.(2) There were no significant difference of tumor characteristics between CRC with T2DM and CRC patients (p>0.05), but in CRC with T2DM patients, especially the hyperinsulinemia, the longest diameter of tumor [(5.50±1.9)cm Vs (4.06±1.53)cm] was bigger, the proportion of C and D stage was higher (73.33%Vs51.52%), and the degree of differentiation was lower (middle-low and low differentiation26.67%Vs9.09%).(3) There were no obvious relationship between fast insulin, C-peptide or IGF-1(P>0.05). But the blood glucose of CRC with T2DM and hyperinsulinemia group had positive effect on IGF-1(r=0.43, r=0.59, respectively, P<0.05).Conclusions1. In recent8years, the incidence of CRC and CRC with T2DM in Tianjin Union Medicine Center increased. The average age, male patients and rate of metastasis of the CRC with T2DM was significantly higher than of CRC group. Last four years, the epidemiology of CRC became serious, as well as the CRC with T2DM.2. All T2DM groups’ insulin secretion delayed and the hyperinsulinemia in prediabetes. and newly diagnosed group was high. With the extension of diabetes history, the insulin levels decrease, but there were still some T2DM patients in hyperinsulinemia for a long time.3. The hyperinsulinemia in CRC with T2DM patients was higher than T2DM. The diabetes history was longer; the proportion of colon cancer and the rate of tumor metastasis was higher, the longest diameter of tumor was bigger, while the degree of differentiation was lower than no-diabetic CRC patients. There were no obvious relationship between fast insulin, C-peptide or IGF-1. |
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