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Metformin therapy and risk of colorectal adenomas and colorectal cancer in type 2 diabetes mellitus patients: A systematic review and meta-analysis
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Abstract
Feifei Liu1,2, Lijing Yan3, Zhan Wang3, Yuanan Lu4, Yuanyuan Chu1,2, Xiangyu Li1,2, Yisi Liu1,2, Dongsheng Rui5, Shaofa Nie6, Hao Xiang1,2
1Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, 430071, China
2Global Health Institute, Wuhan University, Wuhan, 430071, China
3Global Health Research Center, Duke Kunshan university, Kunshan, Jiangsu, 215316, China
4Environmental Health Laboratory, Department of Public Health Sciences, University Hawaii at Manoa, Honolulu, HI 96822 USA
5Department Of Public Health, Medicial College Shihezi University, Shihezi city, 832000, China
6Department of Epidemiology and Biostatistics and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
Correspondence to:
Hao Xiang, email: [email protected]
Keywords: metformin, colorectal adenomas, colorectal cancer, type 2 diabetes mellitus, meta-analysis
Received: September 07, 2016 Accepted: November 16, 2016 Published: December 01, 2016
ABSTRACT
Recent evidence indicates that metformin therapy may be associated with a decreased colorectal adenoma/colorectal cancer risk in type 2 diabetes patients. However, results are not consistent. We therefore performed a systematic review and meta-analysis to assess the association between metformin therapy and risk of colorectal adenomas/colorectal cancer in type 2 diabetes mellitus patients. We searched the literature published before Aug 31, 2016 in four databases: PubMed, Embase database, CNKI and VIP Library of Chinese Journal. Summary risk estimates (adjusted OR/adjusted RR/adjusted HR) with their 95% confidence interval (95% CI) were obtained using a random effects model. Twenty studies (including 12 cohort studies, 7 case-control studies and 1 randomized controlled trial study) were selected in terms of data of colorectal adenomas or colorectal cancer incidence. Metformin therapy was found to be associated with a decreased incidence of colorectal adenomas (unadjusted OR=0.80, 95% CI: 0.71-0.90, p=0.0002). When the adjusted data were analyzed, the summary estimate decreased to 25% reduction in colorectal adenomas risk (adjusted OR=0.75, 95% CI: 0.59-0.97, p=0.03). Besides, a significant reduction of colorectal cancer risk was also observed (unadjusted OR=0.73, 95% CI: 0.62-0.86, p=0.0002). And when the adjusted data were analyzed, colorectal cancer risk for metformin users was decreased with a reduction of 22%, compared with non-metformin users and other treatment users (adjusted OR=0.78, 95% CI: 0.70–0.87, p<0.00001). Our meta-analysis suggested that metformin therapy may be associated with a decreased risk of colorectal adenomas and colorectal cancer in type 2 diabetes mellitus patients.
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