title: Effect of Insulin and Metformin Combination Treatment on Colon Adenoma and Advanced Adenoma Among DM II.
abstract: BACKGROUND
  The risk for colorectal adenoma and advanced adenoma among diabetes mellitus II (DM II) has been debated to differ with the type of anti-diabetic therapy. Insulin increases whereas metformin decreases the risk for colon adenoma (Ad) and advanced Ad (AAd). There have been no studies to evaluate the effect of combination treatment with insulin and metformin on colon Ad and AAd.
  
  
  METHODS
  The retrospective study included DM II patients undergoing screening colonoscopy. Subjects with incomplete colonoscopy, poor bowel preparation, personal history of colorectal cancer (CRC)/inflammatory bowel disease/hereditary nonpolyposis colorectal cancer/familial adenomatosis polyposis/colectomy or family history of CRC were excluded. Subjects were categorized into group 1 (insulin only), group 2 (metformin only), group 3 (combination of insulin and metformin) and group 4 (miscellaneous). Group 4 was excluded from data analysis. Ad detection rate (ADR) and advanced ADR (AADR) were calculated for each group.
  
  
  RESULTS
  Three hundred thirty-nine subjects composed the study group, with a mean age of 60.0 years and male to female ratio of 1:1.4. Composite ADR and AADR for study population was 35.1 and 15.3 %, respectively. Groups 1, 2 and 3 were composed of 88 (26.0 %), 211 (62.2 %) and 40 (11.8 %) subjects, respectively. ADR for groups 1, 2 and 3 was 40.9, 33.2 and 32.5 %, respectively (p value = 0.413). AADR for groups 1, 2 and 3 was 18.2, 15.2 and 10.0 %, respectively (p value = 0.489).
  
  
  CONCLUSIONS
  A decremental trend was observed in ADR and AADR across group 1, group 2 and group 3 (p value >0.05).
authors.affiliation: Internal Medicine Department, Albert Einstein Medical Center, 5401 Old York Road, Philadelphia, PA, 19141, USA. deepanshu.jain.25@gmail.com.
authors.forename: Deepanshu
authors.initials: D
authors.lastname: Jain
authors.affiliation: Internal Medicine Department, Lok Nayak Hospital, Delhi, 110002, India.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chhoda
authors.affiliation: Division of Gastroenterology, Internal Medicine Department, Albert Einstein Medical Center, Philadelphia, PA, 19141, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Uribe
mesh_terms: D000236:Adenoma / Q000188:drug therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D048909:Diabetes Complications / Q000188:drug therapy*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin
keywords: Adenoma; Advanced adenoma; Diabetes mellitus type II; Insulin; Metformin