1. Group 8a Sri Puspita Lingga Sri Muninggar Amalia Nur Pratiwi Harsya Dwindaru Gunardi Rienna Diansari Presentation 1

2. Case Ilustration Mr.X, 72 years, with DM type 2 was administered by insulin injection for more than 10 years. Now, he complains that he has recurrent bleeding stool since 3 months ago. He lost 5kg in two months and had general weakness. From the biopsy, he was diagnosed with colorectal cancer. He then ask to the doctor whether this cancer is becaused by the diabetes that he have been had before?

3. Background The prevalence of DM has been increasing for the last 20 years For Indonesia, WHO predicted the cases increment from 8,4 million in 2000 to ± 21,3 million in 2030 Potential health burden Colorectal cancer is the second leading cause of cancer- related deaths in the United States and the third most common cancer in men and in women. Powers AC. Diabetes Mellitus. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 16th ed: McGraw-Hill; 2005. p. 2152-79. Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia;2011 Colorectal (Colon) Statistics. Centers for Disease Control and Prevention; 2012; Available from: http://www.cdc.gov/cancer/colorectal/statistics/ http://www.cdc.gov/cancer/colorectal/statistics/ A Murdani, Sudoyo AW, Utomo AR, Fauzi A, Rani AA. Molecular profile of colorectal cancer in Indonesia: is there another pathway? Gastroenterol Hepatol Bed Bench 2012;5(2):71-8.

4. Pharmacology intervention Oral hypoglicemic medicine Insulin injection Indication for Insulin therapy Failure with the optimal dose of oral hypoglicemic medicine Stressful (MCI, stroke) Diabetic ketoacidosis Gestational DM Severe liver or kidney dysfunction Contraindication or allergy to Oral hypoglicemic medicine Chronic insulin therapy was associated with a statistically significant increase in colorectal cancer risk among patients with type 2 diabetes Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia;2011 Yang YX, Hennessy S, Lewis JD. Insulin therapy and colorectal cancer risk among type 2 diabetes mellitus patients. Gastroenterology 2004 ; 127 : 1044 – 50

5. PICO Adult Patient /Problem Type 2 Diabetes Mellitus InterventionComparison Colorectal cancer Outcome

6. Clinical Question Does patient with type 2 diabetes mellitus have increased risk of colorectal cancer event? Type of Question Etiology

7. Methods

8. Search Strategy

9. diabetes mellitus OR diabetes mellitus type 2 AND colorectal cancer OR colon cancer OR colorectal malignancy Ebsco Pubmed 231 Inclusion: 10 years, human, systematic review, english 11 Free full text availability 5 5 Screening title & abstract 74061 20 Useful 3 articles Search date: May 24 th, 2012 Major heading: Diabetes mellitus type 2, diabetes mellitus Cochrane 10 11 0 0

10. References Powers AC. Diabetes Mellitus. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 16th ed: McGraw-Hill; 2005. p. 2152-79. Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia;2011 Colorectal (Colon) Statistics. Centers for Disease Control and Prevention; 2012; Available from: http://www.cdc.gov/cancer/colorectal/statistics/ http://www.cdc.gov/cancer/colorectal/statistics/ Yang YX, Hennessy S, Lewis JD. Insulin therapy and colorectal cancer risk among type 2 diabetes mellitus patients. Gastroenterology 2004 ; 127 :1044 – 50 A Murdani, Sudoyo AW, Utomo AR, Fauzi A, Rani AA. Molecular profile of colorectal cancer in Indonesia: is there another pathway? Gastroenterol Hepatol Bed Bench 2012;5(2):71-8.

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