Increase in clinically recorded type 2 diabetes after colectomy - PubMed (original) (raw)

Increase in clinically recorded type 2 diabetes after colectomy

Anders B Jensen et al. Elife. 2018.

Abstract

The colon hosts gut microbes and glucagon-like peptide 1 secreting cells, both of which influence glucose homeostasis. We tested whether colectomy is associated with development of type 2 diabetes. Using nationwide register data, we identified patients who had undergone total colectomy, partial colectomy, or proctectomy. For each colectomy patient, we selected 15 non-colectomy patients who had undergone other surgeries. Compared with non-colectomy patients, patients with total colectomy (n = 3,793) had a hazard ratio (HR) of clinically recorded type 2 diabetes of 1.40 (95% confidence interval [CI], 1.21 to 1.62; p<0.001). Corresponding HRs after right hemicolectomy (n = 10,989), left hemicolectomy (n = 2,513), and sigmoidectomy (n = 13,927) were 1.08 (95% CI, 0.99 to 1.19; p=0.10), 1.41 (95% CI, 1.19 to 1.67; p<0.001) and 1.30 (95% CI, 1.21 to 1.40; p<0.001), respectively. Although we were not able to adjust for several potential confounders, our findings suggest that the left colon may contribute to maintenance of glucose homeostasis.

Keywords: colon; enteroendocrine cells; gut microbiota; human; human biology; medicine; type 2 diabetes.

© 2018, Jensen et al.

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Conflict of interest statement

AJ, TS, OP, TJ, SB, KA No competing interests declared

Figures

Figure 1.

Figure 1.. Study design.

The chart illustrates the number of eligible patients, number of patients excluded and reasons for exclusions, and the final number of patients included. For each colectomy patient, 15 non-colectomy patients were selected among (1) patients who had undergone orthopedic surgery, (2) patients who had undergone abdominal surgery leaving the gastrointestinal tract intact, and (3) patients who had undergone other surgery, unrelated to the gastrointestinal tract. Five non-colectomy patients were selected from each surgery group resulting in inclusion of a total of 694,110 non-colectomy patients matched on age, sex, and year of surgery. Non-colectomy patients were selected using sampling with replacement wherefore the total number of matches are slightly lower than the total number of colectomy patients times 15. Total colectomy includes colectomy and proctocolectomy. T2D: clinically recorded type 2 diabetes.

Figure 2.

Figure 2.. Cumulative hazards of clinically recorded type 2 diabetes.

Cumulative hazards are presented for patients with total colectomy, right hemicolectomy, resection of colon transversum, left hemicolectomy, sigmoidectomy, and proctectomy and for non-colectomy patients. Total colectomy includes colectomy and proctocolectomy. The cumulative hazard was estimated using the Nelson-Aalen estimator. The slopes of the curves equalize the hazard ratios: a slope of 1.00 corresponds to a hazard ratio of 1.00, whereas a slope >1 implies that colectomy patients have a higher risk of type 2 diabetes compared with non-colectomy patients. The linearity attests to the fulfillment of the assumption of proportional hazards in the Cox regression models.

Figure 3.

Figure 3.. Hazard ratio of clinically recorded type 2 diabetes after colectomy.

Hazard ratios are presented for total colectomy, right hemicolectomy, resection of colon transversum, left hemicolectomy, sigmoidectomy, and proctectomy. Total colectomy includes colectomy and proctocolectomy. Hazard ratios are adjusted for age, sex, and year of surgery. T2D: clinically recorded type 2 diabetes.

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