Retrospective histopathological assessment of colon polypectomy specimens in patients with and without Diabetes mellitus

Retrospective Histopathological Assessment of Colon Polypectomy Specimens in Patients With and Without Diabetes Mellitus Objective: Diabetes mellitus (DM) has been associated with colorectal carcinogenesis through metabolic, inflammatory, and epigenetic mechanisms. This study aimed to compare the histopathological features of colorectal polyps in diabetic and non-diabetic patients and to evaluate the potential relationship between diabetes and advanced histology. Materials and Methods: A total of 828 patients who underwent colonoscopy and polypectomy at Celal Bayar University Training and Research Hospital between January 2020 and December 2024 were retrospectively analyzed. Patients were divided into two groups according to the presence of diabetes. Variables such as villous component, dysplasia, polyp localization, and HbA1c level were compared. Findings: The higher prevalence of villous and right-sided adenomas in diabetic patients suggests that diabetes may act as an independent risk factor for colorectal neoplasia. The underlying mechanisms may involve insulin/IGF-1 axis activation leading to enhanced epithelial proliferation, chronic low-grade inflammation, and gut microbiota dysregulation. These findings indicate that diabetes should be regarded not only as a metabolic disorder but also as a condition interacting with inflammatory and epigenetic pathways that may accelerate colorectal carcinogenesis. Therefore, colonoscopic screening in diabetic individuals should emphasize careful inspection of the right colon, personalized bowel preparation strategies, and meticulous follow-up of lesions with villous components. Further multicenter, prospective studies are warranted to elucidate the biological pathways linking diabetes to colorectal neoplasia and to define evidence-based screening strategies tailored to this high-risk population. Conclusion: The increased frequency of villous and right-sided adenomas in diabetic patients suggests a higher colorectal neoplasia risk in this population. Further large-scale prospective studies are needed to determine whether diabetes alone may warrant earlier or more intensive colonoscopic screening. Keywords: Diabetes Mellitus, Colorectal Polyp, Villous Adenoma, HbA1c, Advanced Histology