Tag Archive for: comorbidity

By Parker Lynch

There are several known risk factors for colorectal cancer (CRC): genetic predisposition, age, poor diet, lack of regular physical activity, high alcohol consumption, etc. Recent research is further indicating that other health conditions could also influence an individual’s risk for developing CRC. One such condition is type 2 diabetes, was previously discussed by Emma Edwards (an intern colleague at the Colon Cancer Foundation) in a previous blogpost.

Someone with type 2 diabetes typically has hyperinsulinemia, meaning that they have too much insulin in their blood. Research shows that these higher levels of insulin and sugar in one’s body creates an environment in which CRC can develop more readily. Additionally, higher levels of sugar in the bloodstream typically contributes to more inflammation, which also increases CRC risk. The two factors together mean that someone with type 2 diabetes has a 27% greater chance of developing CRC. 

Severity and Oncological Outcomes

Knowing that there is a link between diabetes and CRC, researchers wanted to specifically hone in on patients with both conditions to understand whether severe diabetes has an impact on CRC survival. 

In a Taiwanese study published in October 2023, data from the country’s Cancer Registry Database was retrospectively analyzed for the period between 2007 and 2015. The 59,202 patients included in this study had diabetes and had undergone curative radical resection for their CRC (stages Ⅰ-Ⅲ), meaning that they had surgery to completely remove their cancerous tumors. The study split the population into three groups: 

  • CRC patients with diabetic complications
  •  CRC patients without diabetic complications
  • CRC patients without diabetes

After conducting the retrospective research, it was found that those with uncomplicated diabetes had an insignificantly worse CRC survival (better survival rates), whereas those with complicated diabetes had a significantly higher risk of poor survival. Women with diabetes, in particular, suffer from more negative CRC outcomes than their male counterparts. These findings indicate that patients who don’t experience diabetic complications will have better CRC outcomes in terms of survival.

One Step At a Time

Managing diabetes alone is a lot of work. Patients must constantly manage their diet, blood glucose levels, physical activity levels, etc. Dealing with CRC on top of diabetes seems impossible. However, patients are encouraged to take their afflictions one step at a time, with the support of their healthcare team by their side, composed of both oncology specialists and endocrinologists. 

Maintaining blood sugar levels and minimizing possible diabetic complications can have a positive impact on CRC outcomes. Though colon cancer and diabetes seem like vastly different conditions, they can go hand-in-hand and should be considered together when developing a treatment plan. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Towfiqu barbhuiya on Unsplash.

As colorectal cancer (CRC) rates rise globally, especially in the early-onset population, identifying high-level risk factors for developing this disease becomes ever more critical. The link between diabetes and the incidence of colon and rectal cancers was discovered in 1998 and has been well-established since then, as many trials have uncovered the strength of the association between these two diagnoses. 

In 2013, a meta-analysis of 26 observational studies among more than 200,000 patients assessed the relationship between CRC and all-cause mortality (death due to any cause), cancer-specific mortality, and disease-free survival. Interestingly, diabetes was found associated with poorer outcomes for all three categories. A key finding from this study: individuals who have diabetes and CRC have a 17% increased risk of death due to any cause.

A 2017 article on the epidemiology of the association between diabetes and CRC delved into the potential molecular mechanisms of this association and the therapeutic implications of treating both diseases, and found that: 

  • Diabetes mellitus and CRC have many overlapping risk factors
  • Hyperinsulinemia, hyperglycemia, and hyperlipidemia may all play a role in the development of these dual diagnoses
  • Environmental and genetic risk factors may also play a role
  • Promising therapies for treating a dual diagnosis are statins, ACE inhibitors, anti-fibrotic agents, among others

A study among 2023 individuals evaluated the association between type 2 diabetes risk, cholesterol levels, triglyceride levels, and CRC. Additionally, the study assessed the association between Lynch syndrome—which results from a genetic mutation that can lead to CRC—and these other variables, and found that:

  • Individuals with Lynch syndrome, type 2 diabetes, and elevated cholesterol levels had an increased risk of CRC
  • High triglyceride levels in those with Lynch syndrome did not increase CRC risk 
  • Hyperinsulinemia and hyperglycemia in diabetic patients may increase the risk of CRC

A more recent study looked at the clinical and therapeutic implications of diabetes treatment and CRC risk. They found that while not always the case, these drugs often reduced the risk of dual diagnosis. Newer therapies, such as anticancer drugs that target IGF-1R and RAGE receptors (receptors for advanced glycation end products), may also help prevent and treat diabetes-induced CRC. 

It will be essential for future research to continue to explore the mechanisms behind these two diseases and to collaborate to create effective treatments for individuals experiencing dual diagnoses.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.