The risk of type 2 diabetes among older Asian, Native Hawaiian and Pacific Islander colorectal cancer survivors:a population-based study using SEER-Medicare database

Cancer Epidemiol Biomarkers Prev. 2025 Apr 14. doi: 10.1158/1055-9965.EPI-25-0037. Online ahead of print.

ABSTRACT

BACKGROUND: While colorectal cancer (CRC) survival rates are improving, the risk of incident type 2 diabetes (T2D) among Asian, Native Hawaiian, and Pacific Islander (ANHPI) ethnic groups is poorly understood. This study aims to identify high-risk groups and quantify the risk across different periods.

METHODS: Using the SEER-Medicare database, CRC survivors who were ANHPI were matched to non-Hispanic White (NHW) survivors at a 1: up to 3 ratio. Multivariable Cox regression models computed hazard ratios (HR) and 95% confidence intervals (CI) for incident T2D.

RESULTS: The study included 6463 NHW and 2901 ANHPI CRC survivors diagnosed between 2000 and 2017. Among them, 715 NHW and 484 ANHPI developed T2D during 39,097 and 10,769 person-years of follow-up, respectively. ANHPI CRC survivors had an elevated T2D risk compared to NHW across all follow-up periods (HRoverall: 1.84, 95% CI: 1.51, 2.25; HR1-5 years: 1.83, 95%CI: 1.45, 2.30). Southeast and East Asians demonstrated the highest T2D risks. Colon cancer was linked to early post-diagnosis T2D risk, while rectal cancer was associated with later risk. No significant association was observed for Native Hawaiian and Pacific Islanders.

CONCLUSIONS: ANHPI CRC survivors face a greater risk of T2D, particularly Southeast and East Asians. These findings highlight the need for evidence-based survivorship strategies to prevent T2D and reduce ethnic disparities.

IMPACT: This is the first study to examine T2D risk among ANHPI CRC survivors, providing critical insights to inform tailored diabetes prevention and survivorship care.

PMID:40227116 | DOI:10.1158/1055-9965.EPI-25-0037