The investigators conducted a population-based analysis using data from Rochester, Minnesota, identifying 2,122 residents aged 50 years and older who met standardized criteria for diabetes for the first time between January 1, 1950, and December 31, 1994. They then tracked how many of these individuals developed pancreatic cancer within three years of their diabetes diagnosis. Rates were compared with expected values from the Iowa Surveillance Epidemiology and End Results (SEER) registry.
In this cohort, 18 individuals (0.85%) were diagnosed with pancreatic cancer within the three-year window. Strikingly, more than half of these cases (56%) were detected within the first six months after the onset of diabetes, and only three underwent surgical resection. The observed-to-expected ratio for pancreatic cancer was 7.94 (95% CI: 4.70–12.55), underscoring a markedly elevated risk compared with the general population.
The team also carried out a nested case-control analysis to examine differences in body mass index (BMI) and smoking status between diabetic patients who developed pancreatic cancer and those who did not.
The study led to the following findings:
- Individuals with pancreatic cancer were more likely to have been diagnosed with diabetes after the age of 69 years (odds ratio 4.52).
- BMI differences between the two groups were not statistically significant (29.2 ± 6.8 vs 26.5 ± 5.0).
- A higher proportion of pancreatic cancer patients reported ever having smoked (92% vs 69%), but this trend did not achieve statistical significance.
Based on these observations, the authors estimate that around 1% of people aged 50 years or older with a new diabetes diagnosis will be diagnosed with pancreatic cancer within three years. Importantly, the temporal relationship—where diabetes onset precedes cancer diagnosis by several months—suggests that new-onset diabetes could potentially act as a clinical clue to underlying pancreatic malignancy.
However, the researchers caution that more work is needed before new-onset diabetes can be routinely used as a screening tool for pancreatic cancer. Identifying which patients warrant further investigation will require additional studies, given the common occurrence of type 2 diabetes in older adults.
"The findings highlight a critical diagnostic opportunity: in select patients, recognizing diabetes as a possible early manifestation of pancreatic cancer could help detect the disease at a stage when surgical intervention is still possible, ultimately improving survival outcomes," the authors concluded.
Reference:
Chari, S. T., Leibson, C. L., Rabe, K. G., Ransom, J., De Andrade, M., & Petersen, G. M. (2005). Probability of Pancreatic Cancer Following Diabetes: A Population-Based Study. Gastroenterology, 129(2), 504-511. https://doi.org/10.1053/j.gastro.2005.05.007
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