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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations
Dimitri F Joseph, Ellen Li, Samuel L Stanley III, Yi-Cong Zhu, Xiao-Ning Li, Jie Yang, Lorenzo F Ottaviano, Juan Carlos Bucobo, Jonathan M Buscaglia, Joshua D Miller, Rajesh Veluvolu, Michele Follen, Evan B Grossman
Dimitri F Joseph, Lorenzo F Ottaviano, Juan Carlos Bucobo, Jonathan M Buscaglia, Joshua D Miller, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794-8173, United States
Ellen Li, Department of Medicine, Division of Gastroenterology, Stony Brook University, Stony Brook, NY 11794-8173, United States
Samuel L Stanley III, Yi-Cong Zhu, Jie Yang, Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY 11794-3600, United States
Xiao-Ning Li, Department of Biostatistics and Bioinformatics Shared Resource, Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794-3600, United States
Jie Yang, Department of Family, Population, and Preventative Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794-8461, United States
Rajesh Veluvolu, Evan B Grossman, Department of Medicine, NYC Health and Hospitals/Kings County, Brooklyn, NY 11203, United States
Rajesh Veluvolu, Evan B Grossman, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, United States
Michele Follen, Department of Obstetrics and Gynecology, NYC Health and Hospitals/Kings County, Brooklyn, NY 11203, United States
Author contributions: Grossman EB, Follen M, Miller JD and Li E performed the study concept and design; Joseph DF, Li E, Grossman EB, Ottaviano LF and Bucobo JC collected data; Joseph DF, Stanley III SL, Zhu YC, Li XN and Yang J performed the statistical analysis; Joseph DF and Li E drafted the manuscript; Li XN, Yang J, Ottaviano LF, Bucobo JC, Buscaglia JM, Miller JD, Veluvolu R and Follen M performed critical reviews of important intellectual content; all authors approved the final version of the manuscript.
Supported by Stony Brook University Targeted Research Opportunity Seed Fusion Grant, No. 1135373-3-37298; National Cancer Institute, No. P20 CA192994; Simons Foundation, No. 415604.
Institutional review board statement: The study was reviewed and approved by the Stony Brook University Institutional Review Board, No. 180023; SUNY Downstate Medical Center Institutional Review Board, No. 802718.
Informed consent statement: A waiver of consent was obtained by both the SUNY DMC and Stony Brook University IRBs for retrospective collection and analysis of deidentified demographic and medical data.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ellen.li@stonybrookmedicine.edu. A waiver of consent was obtained by both the SUNY DMC and Stony Brook University IRBs for retrospective collection and analysis of deidentified demographic and medical data. Because the presented data are deidentified, the risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ellen Li, MD, PhD, Emeritus Professor, Department of Medicine, Division of Gastroenterology, Stony Brook University, HSC T17-060, Stony Brook, NY 11794-8173, United States. ellen.li@stonybrookmedicine.edu
Received: December 5, 2020
Peer-review started: December 5, 2020
First decision: December 17, 2020
Revised: December 23, 2020
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: April 16, 2021
ARTICLE HIGHLIGHTS
Research background
Multiple factors, including both social determinants of health (e.g., access to quality healthcare) and biological gene-environment factors that may promote oncogenic transformation, have been implicated in the persistently increased colorectal cancer (CRC) incidence and mortality in Black/African Ancestry (AA) individuals compared with those of all other races in the United States.
Research motivation
We explored how these multiple factors affect the risk of adenoma, a precursor stage for CRC, during index colonoscopies performed at two hospitals located 50 miles apart that serve two very disparate populations. While type 2 diabetes (T2DM) has been associated with increased adenoma detection in predominantly White/European Ancestry (EA), one of the few studies conducted on a predominantly Black/AA population detected no significant effect of T2DM on adenoma risk in Black/AA women.
Research objectives
To measure the univariate effect of T2DM on the adenoma detection rate (ADR) in a predominantly Black/AA population, recent hemoglobin A1c (HbA1c) levels were used to further stratify the nondiabetic patients into prediabetic patients (pre-DM) and controls with normal glycemic status (control). To conduct a multivariable analysis of the effect of race and diabetes status in the combined datasets collected on a predominantly underinsured Black/AA population and a predominantly insured White/EA population while controlling for multiple factors.
Research methods
The datasets were assembled by manual curation of endoscopy and clinical records in the electronic medical record at each hospital using the same vocabulary. Multivariable analysis utilized generalized linear mixed models, which incorporated both fixed effects (age, sex, race, diabetes status, obesity, smoking status, aspirin use and insurance status) and random effects (institution and individual colonoscopists).
Research results
The ADR was significantly higher in the T2DM group than in the control group in the predominantly underinsured Black/AA population, but no significant difference in the ADR was detected for the pre-DM group compared to both the T2DM group and the control group. T2DM along with age, obesity, smoking status, and male sex were significantly associated with a higher ADR after combining the datasets for the two disparate populations. Race, insurance status and aspirin use were not significant.
Research conclusions
These results indicate that T2DM increases adenoma risk in both Black/AA and White/EA individuals.
Research perspectives
We plan to conduct a prospective study recruiting patients scheduled for index screening colonoscopies at both institutions to measure HbA1c and fasting blood glucose preprocedure. We plan to refer individuals with abnormal levels for the management of prediabetes and diabetes.
