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. 2019 Nov;10(11):e00092.
doi: 10.14309/ctg.0000000000000092.

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

Joshua Demb  1   2 , Armaan Yaseyyedi  3 , Lin Liu  2   4   5 , Ranier Bustamante  5 , Ashley Earles  5 , Pradipta Ghosh  1   2   6   7 , J Silvio Gutkind  1   2   8 , Andrew J Gawron  9   10 , Tonya R Kaltenbach  11   12 , Maria Elena Martinez  2   4 , Samir Gupta  1   2   7
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Metformin Is Associated With Reduced Odds for Colorectal Cancer Among Persons With Diabetes

Joshua Demb et al. Clin Transl Gastroenterol. 2019 Nov.

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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Figures

Figure 1.
Figure 1.
Association of metformin exposure with colorectal cancer risk. The forest plot depicts ORs for CRC unadjusted, as well as adjusted for age, sex, race/ethnicity, body mass index, smoking status, and aspirin exposure, for all sites overall, as well as stratified by anatomic site. CRC, colorectal cancer; OR, odds ratio.
See this image and copyright information in PMC

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