Abstract 7603: Type-2 Diabetes, medications, and risk of multiple colorectal polyps: A colonoscopy-based study using natural language processing.

Abstract Introduction: Colorectal polyps are known precursors to colorectal cancer (CRC), and a higher polyp count is associated with an increased CRC risk. This study aimed to investigate the impact of type-2 diabetes (T2D) and its treatments on polyp count. Methods: We leveraged pathology reports from the University of Utah (UofU) Enterprise Data Warehouse (EDW) to develop a rule-based natural language processing pipeline, to extract polyp diagnoses and features (site, count) for 38,038 patients who underwent colonoscopy at the UofU Gastroenterology clinic from 2011-2020. We identified 6,556 patients with T2D via ICD codes and anti-diabetes medication prescriptions. Patient characteristics were extracted from the EDW, including age, sex, race, smoking, BMI, anti-inflammatory medication use, and active prescriptions for insulin, metformin, sulfonylureas, GLP-1 agonists, and DPP-4 inhibitors. Polyp count was categorized as none, one, or multiple. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for polyp counts were calculated using multinomial logistic regression. Results: Patients were on average 56 years old, 84% White, 51% female, with a mean BMI of 30 kg/m2. 73% of patients with T2D used anti-diabetes medications. T2D alone was not associated with multiple polyps, but patients with T2D taking anti-diabetes medications had a lower risk of polyps overall, irrespective of polyp count. Insulin use was associated with an increased risk of one or multiple polyps [OR(95%CI)=1.29(1.08-1.54) and 1.40(1.18-1.66), respectively], compared to other medications. Metformin and GLP-1 agonists were both associated with a decreased risk of one [Metformin OR(95% CI)=0.71(0.59-0.85), GLP-1=0.79(0.64-0.99)] or multiple polyps [Metformin OR(95% CI)=0.71(0.52-0.73), GLP-1=0.63(0.51-0.77)], compared to patients taking medications other than metformin or GLP-1 agonists, respectively. Compared to patients taking no anti-diabetes medications, those on insulin, metformin, DPP-4 inhibitors, or sulfonylureas had an increased risk of at least one polyp, while patients taking GLP-1 agonists had a lower risk of multiple polyps [OR(95%CI)=0.81(0.63-1.03)]. DPP-4 inhibitors and sulfonylureas also had a lower risk of multiple polyps [OR(95%CI)=0.79(0.64-0.97) and 0.80(0.68, 0.96), respectively]. Conclusion: Overall, T2D alone was not associated with polyp count, but medication use modified this relationship. Insulin use was associated with increased risk, whereas the use of metformin, GLP-1 agonists, DPP-4 inhibitors, and sulfonylureas was associated with decreased risk of one or multiple polyps, compared to patients taking other anti-diabetes medications. These results highlight the potential role of T2D medication choice in altering colorectal polyp risk, underscoring the need for more research into underlying mechanisms to guide potential interventions. Citation Format: Jessica van Onselen, Ryzen Benson, Stephanie Richardson, Maci Winn, Candace Winterton, Svenja Pauleck, Ainhoa Gomez-Lumbreras, Polly A. Newcomb, Cornelia M. Ulrich, John Inadomi, Sheetal Hardikar. Type-2 Diabetes, medications, and risk of multiple colorectal polyps: A colonoscopy-based study using natural language processing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 7603.