The population-based cohort study analyzed 3,856,676 adults aged 20 years and older who underwent routine health examinations in 2009 through medical institutions designated by the Korean National Health Insurance Service. The participants were followed for a median of 10.3 years, through December 2020, allowing for assessment of long-term outcomes.
At baseline, 8.6% of participants (330,138 individuals) had diabetes. Over the course of follow-up, 31,877 participants (0.8%) were newly diagnosed with pancreatic cysts. This research categorized participants into four groups as normoglycemia (normal blood glucose), impaired fasting glucose (a prediabetic state), diabetes of less than five years’ duration, and diabetes lasting five years or more.
When compared to individuals with normal glucose levels, those with impaired fasting glucose had a modestly increased risk of pancreatic cysts (AHR 1.06). The risk climbed among individuals with diabetes for less than 5 years (AHR 1.23) and rose further for those with diabetes lasting five years or more (AHR 1.37). This pattern suggests that both the presence and duration of diabetes play a role in pancreatic cyst development.
Adults under age 60 with diabetes had a higher relative risk (AHR 1.34) when compared to those aged 60 and older (AHR 1.21). Men with diabetes faced greater risk (AHR 1.32) than women (AHR 1.20). Smoking status also influenced outcomes, where current smokers with diabetes had the highest observed risk (AHR 1.40), compared to never smokers (AHR 1.22) and former smokers (AHR 1.25). The data indicate that smoking cessation may reduce some of the elevated risk associated with diabetes.
The large sample size and long follow-up of this study strengthen its conclusions, though the findings of this research note that imaging-based and longitudinal assessments are needed to clarify how many of these cysts progress to clinically significant disease.
Given that certain pancreatic cystic neoplasms are considered precancerous, identifying modifiable risk factors like glycemic control and smoking could prove vital. As imaging technology becomes more widespread and detection rates rise, these findings point to the importance of integrated metabolic and cancer-prevention strategies in long-term diabetes care.
Source:
Cho, I. R., Chang, S. H., Lee, S. H., Han, K.-D., Chung, K. H., Lee, M. W., Choi, J. H., Paik, W. H., & Ryu, J. K. (2026). Pancreatic cystic neoplasm risk among individuals with diabetes. JAMA Network Open, 9(2), e2556951. https://doi.org/10.1001/jamanetworkopen.2025.56951
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