Mo1057 Metformin, Insulin Therapy and Risk of Colorectal Neoplasia Among African American With Type 2 Diabetes Mellitus

without colonic neoplasia at colonoscopy were identified. Data was analyzed using chisquare tests and multivariate logistic regression. Results: We identified 214 patients with T2DM who were on anti-diabetic medications for at least 6 month prior to colonoscopy. Of these patients 156 (72.9%) had histopathologically confirmed colorectal neoplasia and 58 (27.1%) had no neoplasia We found that 67 (43%) patients with colorectal neoplasia were on metformin therapy compared to 35 (60%) patients without evidence of colorectal neoplasia (P=0.026). Multivariate logistic regression adjusted for age and gender demonstrated that patients on MT for more than 5 years had significantly decreased risk OR= 0.2(95% CI: 0.1-0.4, P<0.001). Insulin dose was a significant risk factor for neoplastic GI lesion in a separate multivariate analysis OR=1.03 (95% CI:1.01-1.05 for each unit). Conclusion: Our findings suggest that MT therapy is associated with lower risk while insulin therapy is associated with high risk of colorectal neoplastic lesions in AA with T2DM. MT protective effect appears to increase with duration of therapy. Mo1058 Hospital Inpatient Population Diversity Is Associated With Major Complication Rates for Five Common Gastrointestinal Diagnoses Derrick Stobaugh, Philip N. Okafor, Jayant A. Talwalkar Background: We sought to characterize the relationship between hospital inpatient racial diversity and the development of major complications (MC) and less severe complications (LSC) during hospitalization for five common gastrointestinal tract (GI) diagnoses. Methods: The 2012 National Inpatient Sample (NIS) database contains 7.3 million discharges, across 4,378 hospitals, with sampling weights to estimate 36.5 million discharges nationally. Racial diversity was defined by the percentage of White patients discharged from each hospital that year. Five of the most common GI discharge diagnoses were chosen based on frequency and defined by diagnostic related grouping (Table 1). Logistic regression was used to predict whether a patient had a LSC or MC. Hospitalizations without any complications were excluded to minimize bias. Control variables included age, gender, race, condition type, payer type, patient location, area associated income quartile, hospital size, urban vs. rural, teaching vs. nonteaching hospital, hospital region and ownership, percent of White patients, and the interaction of hospital diversity with outcomes by race. Financial implications were also calculated for total charges. Results: There were 747,650 discharges across 3,631 hospitals. At the hospital level, the patient population was, on average, 60% White (standard deviation ± 26%). Hospital level control variables can be seen in Table 2, where hospital location and teaching status had the most profound effect. Although the hospital patient population diversity was not a significant predictor of MC (adjusted Odds Ratio (OR) 0.96; 95% Confidence Interval (CI) 0.92 - 1.01), there was a significant interaction between hospital inpatient population diversity and outcomes by race, meaning the impact of hospital diversity on MC rates differed depending on the race of the patient. Relative to white patients, African American (AA) patients tended to have a higher odds of MC when visiting hospitals that tended to be less diverse (adjusted OR 1.09; 95% CI 1.02-1.16). Conversely, Hispanic and Latino patients tended to have a lower odds of MC when the patient population was less diverse (adjusted OR .85; 95% CI 0.79-0.91). Similarly, Asian patients also tended to have a lower odds of MC when the patient population was less diverse (adjusted OR .85; 95% CI 0.75-0.97). Finally, average total charges were calculated if the rate of LSC, relative to MC, was similar among different races relative to White patients. Overall, there would be a savings of $27.8 million for all AA patients, $22.0 million for all Hispanic and Latino patients, and $3.8 million for all Asian patients for these five conditions. Conclusion: The diversity of the patient population for a given hospital appears to impact the rate of MC for different races. This effect has major ramifications related to total charges. Table 1: Distribution of Gastrointestinal Diagnoses and Complication Rates by Reported Race

*Costs shown in British Sterling Pence (GBX) per 100g Table 2: Cost comparison of GF food between supermarkets and online retailers

*Costs shown in British Sterling Pence (GBX) per 100g Mo1057 Metformin, Insulin Therapy and Risk of Colorectal Neoplasia Among African American With Type 2 Diabetes Mellitus Armana Saeed, Mehdi Nouraie, Anahita Shahnazi, Edward L. Lee, Babk Shokrani, Gail Nunlee-bland, Yassin M. Mustafa, Adeyinka O. Laiyemo, Hassan Brim, Sahar Geramfard, Hassan Ashktorab

LSC: Less Severe Complications MC: Major Complications N: Number Table 2: Impact of Hospital Characteristics on Developing Major Complications

Background: Type 2 diabetes mellitus (T2DM) patients are at increased risk for colorectal carcinoma (CRC). Obesity, insulin resistance and hyperinsulinemia either endogenous or exogenous have been linked to increasing CRC risk in these patients. Metformin which is an insulin sensitizer is suggested to decrease the risk of colorectal neoplastic lesions namely CRC and its precursor colorectal adenoma. Additionally, it may also reduce the mortality and increase survival in patients with established CRC. These findings can be partially explained by the suppressive action of metformin on malignant cell growth in vivo. Aim: To evaluate the association between metformin and insulin therapy on prevalence colorectal neoplasia among African Americans (AA) with T2DM. Methods: We reviewed the medical records of diabetic patients who had colonoscopy in our institution between Jan 2000 to Dec 2012. A group of AA diabetic patients who had colonic neoplasia and a control group

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AGA Abstracts

AGA Abstracts

limited2. We hypothesised that this may preclude good adherence in lower socioeconomic groups. We aimed to assess the availability and cost of GF foods across a range of supermarkets in a single UK city (Sheffield). We also aimed to assess the impact online retailers had on the GF food market. Methods: 67 supermarkets were analysed, including a range of categories, sizes and locations. 10 items were selected to represent a range of commonly bought GF foods and the price and availability of these items was recorded. Where any were found, the price of their gluten-containing counterpart was also recorded. Other data collected included the store size, location, length of any gluten free section(s) and total number of GF items on sale. The same factors were used to assess online retailers. Results: Of the 67 supermarkets visited, 27 (40.3%) stocked no GF items, with the remaining 40 (59.7%) stocking at least one. The mean number of GF items sold per store was 30, but this varied greatly by store category and size. None of the budget or corner supermarkets surveyed stocked any GF items. Regular and luxury supermarkets had a greater range (p<0.001), stocking 37 and 55 items on average respectively, as did larger supermarkets in general (MW p<0.001). In terms of the ten items specifically surveyed, 31 (46.3%) stores stocked none of the items, with the remaining 36 (53.7%) stocking at least one; the average across all stores was 40.9%. Overall, GF items cost significantly more than their gluten-containing counterparts (table 1), with GF items costing on average 4.1 times more. All 21 online stores surveyed sold at least one GF item. The average number of GF items sold was 609, compared with 30 for stores (p<0.001). The proportion of highlighted items sold was also significantly higher, with an average of 73.3% sold (p<0.001). Despite a larger range, the average cost of GF items online was higher than in stores (table 2). Conclusions: The availability of GF food in budget supermarkets and corner shops is lacking and GF food remains significantly more expensive. The greatest availability is online and in larger regular/ luxury supermarkets. The issue remains that this could prevent lower socioeconomic groups from fully adhering to a GF diet. References 1. West J et al. Incidence and Prevalence of Celiac Disease and Dermatitis Herpetiformis in the UK Over Two Decades: Population-Based Study. Am J Gastroenterol 2014; 109:757-768 2. Singh J and Whelan K. Limited Availability and Higher Cost of Gluten-Free Foods. J Hum Nutr Diet 2011; 24:479-486 Table 1: Cost comparison of GF foods with gluten-containing equivalents