Type 2 diabetes (DM) and colorectal cancer (CRC) are chronic diseases with major health implications in the United States and the Middle East; in fact, the rate of rise in prevalence of type 2 DM and CRC in the Middle East is amongst the highest in the world. Patients with type 2 DM have higher all-cause mortality, and CRC-specific mortality when compared to those patients without type 2 DM. Furthermore, type 2 DM CRC patients treated with the hypoglycemic agent metformin, in two recently reported retrospective series (including data from our institution), had a superior overall survival, and compared to those not receiving metformin. Metformin has been demonstrated to have direct antiproliferative activities in vitro; it may have its direct anti-cancer action through direct activation of the liver kinase B1 (LKB1)-5’AMP-activated protein kinase (AMPK) pathway with secondary inhibition of the mammalian target of rapamycin (mTOR) leading to cancer cell apoptosis. This proposed study aims to validate our preliminary findings, by looking at a larger sample size, and a more heterogeneous ethnic patient population.