Updated Colon Cancer Screening Guidelines in Diabetic Population: An Experience from Diabetic Clinic

Objective:
Patients with type 2 diabetes mellitus (DM) have an increased risk of developing colorectal cancer (CRC) as compared to the general population. The United States Preventative Task Force (USPSTF) updated guidelines in 2021 changed the age criterion from 50 to 45 to recommend screening for CRC in all adults. This is a class B recommendation with moderate net benefit. Considering high risk for CRC, it is even more important for our diabetic patients to have a CRC screening starting at age 45. The primary aim of this study was to look into adaptation of the new colonoscopy recommendation for eligible patients. This study is expected to help us identify a lapse in care for our high risk patients with diabetes. We plan to develop tools to see if we can improve the rate of CRC screening in diabetic patients by chart review and implementing electronic medical records reminders.

Methods:
Inclusion criteria were adults aged 44–49 years with a diagnosis of type 2 diabetes mellitus. 35 patients met these criteria and we reviewed their records for gastroenterology evaluation with a colonoscopy or such recommendation. If any of our subjects underwent colonoscopy for symptoms, they were not counted towards the compliance with new guidelines that are geared towards screening in asymptomatic individuals without a family history of CRC. The analysis was done using Data ToolPak of Excel.

Results:
Mean age of our cohort was 46.3 years. There were 42.8% (n=15) males and 57.2% (n=20) females. 17.1% (n=6/35) had undergone gastroenterology evaluation with a colonoscopy for other causes such as Crohn’s disease. In the remaining 82.9% (n=29/35) who did not have their screening colonoscopy yet, only 11.5% (4/35) were recommended getting colonoscopy in the diabetes clinic and 71.4% (n=25/35) had no documentation of the screening colonoscopy recommendation. All 35 patients had a BMI over 25, with mean BMI of 37.1 which itself is a risk factor for CRC.

Discussion/Conclusion:
The USPSTF recommends that adults aged 45 to 75 be screened for CRC. Our results identify the need for improvement in recommending screening colonoscopies to our eligible DM patients. Increased risk for CRC in DM is due to insulin resistance, chronic inflammation, and other metabolic abnormalities. Patients with diabetes have a higher risk of complications from CRC. Overall, promoting CRC screening in patients with diabetes requires a multifaceted approach that may involve raising awareness through posters in clinics, reinforcing the updated age 45 guideline, providing text messages or email reminders, offering all available screening tools, including home kits, and working with healthcare providers to address the barriers to age-appropriate screening. With more insurance companies covering early colonoscopies and healthcare better able to overcome the pandemic, early detection and timely treatment can help decrease morbidity and mortality from colon cancer in this high-risk population.