Using New Onset Diabetes to Predict Pancreatic Cancer

by U.S. Medicine

January 4, 2016

LOUIS — New-onset diabetes mellitus (NODM) in adults can be an indicator of pancreatic cancer, although the incidence remains low in that cohort. A new study sought to determine whether other factors could help determine when concerns about pancreatic cancer (PaCa) should be increased.

For the report, published in Clinical and Translational Gastroenterology, Saint Louis University School of Medicine researchers looked at other patient factors such as age, smoking history, the absence of obesity, the presence of chronic pancreatitis (CP) and gallstone disease.1

For the study, 452,804 veterans in the VHA database were followed for development of DM or PaCa. About 16%, 73,811, were diagnosed with diabetes during the study period. Of those, 234 (0.32%) also were diagnosed with pancreatic cancer, compared to 0.23% of the group that had not had a new diagnosis of diabetes after enrollment in the study.

Results indicated that PaCa also was diagnosed within three years following NODM in 183/73,811(0.25%) patients, which was significantly higher than the 0.11% of the controls.

Over the entire study period 1,092 patients were diagnosed with PaCa (0.24%), with 234 of them, 21.4%, diagnosed with NODM preceding the cancer discovery.

PaCa incidence decreased progressively each year following NODM and was not significantly higher than in controls after three years, the study pointed out.

The risk of PaCa diagnosis was higher among patients who were nonobese (RR=1.51), were ≥65 years old (RR=2.01), were heavy smokers (RR=1.55) and had a history of CP (RR=4.72) or gallstone disease (RR=2.02), the study found. Using a combination of these risk factors in NODM patients resulted in up to 0.72% three-year risk of PaCa but captured only 17% of patients with PaCa, study authors noted.

“Based on our findings, the likelihood of PaCa in adults with NODM even after adjusting for other potential risk factors for PaCa including age, body mass index, smoking, gallstones, and CP is probably not high enough to recommend routine evaluation for all these patients for underlying PaCa,” the researchers concluded.

1 Munigala S, Singh A, Gelrud A, Agarwal B. Predictors for Pancreatic Cancer Diagnosis Following New-Onset Diabetes Mellitus. Clin Transl Gastroenterol. 2015 Oct 22;6:e118. doi: 10.1038/ctg.2015.44. PubMed PMID: 26492440. 

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