Small bowel resection is associated with a reduced risk for type 2 diabetes (T2D) among patients with Crohn disease (CD), and large bowel resection is associated with an increased risk for T2D in those with ulcerative colitis (UC), according to study results published in Gastro Hep Advances.
The population-based, prospective study enrolled patients with CD undergoing small bowel resection and patients with CD or UC undergoing large bowel resection in Denmark from January 1, 1996, to December 31, 2018. The Danish National Patient Register and the Danish National Prescription Register were used to identify incident cases of T2D. All study participants were aged 15 years and older.
The analysis included 2469 patients with CD and small bowel resection and 5148 patients with either CD (n = 1361) or UC (n = 3787) and large bowel resection.
Researchers followed patients with CD and small bowel resection and 12,331 matched patients with CD and no history of bowel resection for T2D. The group’s mean age at the time of small bowel resection was 39.3±17.1 years, and 56% were women. The patients had a median CD duration of 1.1 (IQR, 0.1-4.6) years at the time of resection.
The patients with CD and small bowel resection also had a cumulative T2D incidence of 2.4% (95% CI, 1.7-3.4) after 10 years, compared with 3.6% (95% CI, 3.2-4.1) in the matched CD population. The adjusted hazard ratio (aHR) of T2D was 0.65 (95% CI, 0.44-0.92) in patients with CD with vs without small bowel resection, according to Cox regression modeling.
The patients with CD and UC undergoing large bowel resection were matched with 6763 participants with CD and 18,932 with UC with no history of bowel resection, respectively. The group’s mean age at the time of large bowel resection was 45.9±19.3 years for patients with CD and 47.0±19.3 years for those with UC; 51% were women. The patients with CD and UC had a median IBD duration of 2.2 (IQR, 0.1-7.3) and 2.4 (IQR, 0.4-7.8) years, respectively, at the time of resection.
The patients with CD and large bowel resection and the matched CD group had a comparable cumulative incidence of T2D. Per Cox regression analysis, the aHR of T2D was 0.95 (95% CI, 0.67-1.31) in the patients with CD and large bowel resection vs without large bowel resection. The cumulative T2D incidence in patients with UC and large bowel resection was 6.4% (95% CI, 5.4-7.6) after 10 years, compared with 4.7% (95% CI, 4.3-5.1) in the matched UC population. The aHR of T2D was 1.25% (95% CI, 1.03-1.51) in the patients with UC and large bowel resection vs UC without large bowel resection.
Among several study limitations, some heterogeneity may be possible, and the registers did not include data on variables such as adiposity or body mass index. In addition, a risk of misclassification of the outcome of T2D is possible, and the study may have lacked adequate power to detect differences in subgroups.
The researchers concluded that “in patients with CD who undergo small bowel resection, the risk [for] T2D was lower, and in patients with UC who undergo large bowel resection, the risk [for] T2D was higher, compared [with] IBD patients who did not undergo bowel resection surgery.”
Allin KH, Agrawal M, Iversen AT, Antonsen J, Villumsen M, Jess T. The risk of type 2 diabetes in patients with inflammatory bowel disease after bowel resections: a nationwide cohort study. Gastro Hep Advances. Published online June 16, 2022. doi:10.1016/j.gastha.2022.06.007