Seoul, Korea—Following their medication regimen is directly related to reduced mortality in diabetes mellitus patients who have colorectal cancer, according to a new study.

A report in Cancer Epidemiology, Biomarkers & Prevention says that Korean patients with both conditions had a significantly reduced risk of lower mortality if they also had high adherence to their oral diabetes medication versus those with lower adherence.

“It is estimated that only 60 percent of those with diabetes are taking their antidiabetic medications as directed,” explained senior author Aesun Shin, MD, PhD, professor in the Department of Preventive Medicine at Seoul National University College of Medicine; “We wanted to study whether adhering to diabetes medications has an impact on survival among patients with colorectal cancer."

Background information in the article explains that diabetes mellitus is known to have a negative effect on colorectal cancer survival due to hyperinsulinemia or hyperglycemia. On the other hand, medications such as metformin, which targets insulin resistance and hyperinsulinemia, are known to have a preventive effect when it comes to mortality.

Researchers said they wanted to compare the risk of death among patients who have colorectal cancer with diabetes and different levels of adherence to oral antidiabetics. To do that, they used the National Health Information Database, which has all claims data for those who are registered for national health insurance in Korea. Accessing data from 2002 to 2016 for the retrospective cohort study, the study team focused on 33,841 diabetic patients with newly diagnosed colorectal cancer for an average of 4.7 years. Participants were followed up from the date of diagnosis until death or December 31, 2016. For purposes of the study, medication adherence was calculated as the proportion of days covered (PDC).

Results indicate that patients with colorectal cancer with good adherence (PDC ≥80%) showed a reduced risk of death [HR (95% CI), 0.82 (0.78-0.86)] compared with those with poor adherence (PDC <80%). A reduced risk of death was observed for all cancer subsites, researchers note.

“The maintenance of good medication adherence for diabetes mellitus was related to a favorable prognosis of colorectal cancer,” the authors point out, adding, “This study provides evidence that patients with colorectal cancer who are adherent to their diabetes medication will have better survival than patients who are not adherent.

Researchers write that more than 80% of patients were taking more than one oral antidiabetic medication but less than 23% were in the high-adherence category.

Compared with patients with high adherence, they explain, those with low adherence to their oral antidiabetic medication had a nearly 20% increase in their risk of overall mortality, in both crude and adjusted models. Yet high adherence to oral antidiabetic medication was found to have a protective effect for all colorectal cancer subgroups, with the most pronounced effect observed among patients with distal colon cancer.

“Based on our data, less than 25 percent of patients were taking their diabetes medications as prescribed, suggesting that over 75 percent of diabetic patients with colorectal cancer could benefit by adhering to these prescriptions,” Dr. Shin emphasized.

The researchers also determined that patients who underwent surgery, surgery plus radiotherapy, or surgery plus chemotherapy had a protective benefit if they had high adherence to oral antidiabetic medications. Patients who received surgery with both radiotherapy and chemotherapy or patients who received radiotherapy or chemotherapy without surgery did not have a protective benefit, however, even if they had a high adherence.

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