Endocrinol Metab.  2021 Oct;36(5):1069-1077. 10.3803/EnM.2021.1119.

Risk of Diabetes in Subjects with Positive Fecal Immunochemical Test: A Nationwide Population-Based Study

• Kim KW
• Lee HJ
• Han K
• Moon JM
• Hong SW
• Kang EA
• Lee J
• Soh H
• Koh SJ
• Im JP
• Kim JS

• KMID: 2521954
• DOI: http://doi.org/10.3803/EnM.2021.1119

Abstract

Background
Positive fecal immunochemical test (FIT) results have been recently suggested as a risk factor for systemic inflammation. Diabetes induces inflammation in the gastrointestinal tract via several ways. We investigated the association between FIT results and the incidence of diabetes.
Methods
A total of 7,946,393 individuals aged ≥50 years from the National Cancer Screening Program database who underwent FIT for colorectal cancer (CRC) screening from 2009 to 2012 were enrolled. The primary outcome was newly diagnosed diabetes based on the International Classification of Disease 10th revision codes and administration of anti-diabetic medication during the follow-up period.
Results
During a mean follow-up of 6.5 years, the incidence rates of diabetes were 11.97, 13.60, 14.53, and 16.82 per 1,000 personyears in the FIT negative, one-positive, two-positive, and three-positive groups, respectively. The hazard ratios (HRs) for the incidence of diabetes were 1.14 (95% confidence interval [CI], 1.12 to 1.16; HR, 1.21; 95% CI, 1.16 to 1.27; and HR, 1.40; 95% CI, 1.28 to 1.55) in the one-positive, two-positive, and three-positive FIT groups compared with the FIT negative group, respectively. The effect was consistent in individuals with normal fasting blood glucose (adjusted HR 1.55 vs. 1.14, P for interaction <0.001).
Conclusion
Positive FIT results were associated with a significantly higher risk of diabetes, suggesting that the FIT can play a role not only as a CRC screening tool, but also as a surrogate marker of systemic inflammation; thus, increasing the diabetes risk.

Keyword

Occult blood; Diabetes mellitus; Inflammation; Surrogate marker; Population; Cohort studies

Figure

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  Fig. 1. Study flow of population enrollment. CRC, colorectal cancer; FIT, fecal immunochemical test.

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  Fig. 2. Cumulative risk of diabetes associated with the number of fecal immunochemical test results. FIT, fecal immunochemical test.

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