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Study Finds Recent-Onset Type 2 Diabetes May Be Early Manifestation of Pancreatic Cancer

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Key Points

  • Recent-onset type 2 diabetes may be an early expression of pancreatic cancer, and long-standing diabetes is a risk factor for this cancer.
  • While diabetes was associated with a more than 2-fold higher risk of pancreatic cancer in African Americans and Latinos, recent-onset diabetes was associated with a 2.3-fold greater increase in risk of the malignancy in these minority populations.
  • Patients with recent-onset diabetes who go on to develop pancreatic cancer represent a high-risk population of patients who can be studied for additional risk predictors and may be targeted for development of the tests that are needed for an earlier diagnosis—and improved patient outcomes.

According to the American Cancer Society, pancreatic cancer is one of the most deadly cancers, with an overall 5-year survival rate of just 8%, mainly because the vast majority of patients, about 80%, are diagnosed at a late stage of disease. Research has shown that identification of high-risk individuals and the ability to detect pancreatic cancer at an earlier stage might help improve patient outcomes. A large prospective study investigating the relationship between recent-onset diabetes and the incidence of pancreatic cancer in African Americans and Latinos has found that while diabetes was associated with a more than 2-fold higher risk of the cancer, recent-onset diabetes was associated with a 2.3-fold greater increase in risk of pancreatic cancer in these minority populations. The study’s findings suggest that recent-onset diabetes is a manifestation of pancreatic cancer and that long-standing diabetes is a risk factor for this cancer. The study by Setiawan et al is published in the Journal of the National Cancer Institute.

Study Methodology

The researchers analyzed data from 48,995 participants (20,403 African Americans and 28,592 Latinos) in The Multiethnic Cohort Study, from 1993–1996, to examine the relationship between recent-onset diabetes and pancreatic cancer. The researchers also used a combination of follow-up questionnaires, Centers for Medicare and Medicaid Services Medicare Chronic Conditions files, and the California Office of Statewide Health Planning and Development hospital discharge files to indentify new diabetes diagnoses.

Cox regressions were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer associated with diabetes and with diabetes duration.

Study Findings

The researchers found that a total of 15,833 (32.3%) of the participants developed diabetes between baseline and 2013. A total of 408 incident pancreatic cancer cases were identified during follow-up. Diabetes was associated with pancreatic cancer (HRage 75 = 2.39, 95% confidence interval [CI] = 1.91–2.98). Individuals with recent-onset diabetes (within 3 or fewer years of a pancreatic diagnosis) had a greater risk compared to those with long-term diabetes across all ages. The HRage 75 for recent-onset diabetes was 4.08 (95% CI = 2.76–6.03 in Latinos and 3.38 (95% CI = 2.30–4.98) in African Americans.

“Diabetes was associated with a more than 2-fold higher risk of pancreatic cancer in African Americans and Latinos, but recent-onset diabetes was associated with a 2.3-fold greater increase risk of pancreatic cancer than long-standing diabetes. Our findings support the hypothesis that recent-onset diabetes is a manifestation of pancreatic cancer and that long-standing diabetes is a risk factor for this malignancy,” concluded the study authors.

Recent-Onset Diabetes May Be a Consequence of Pancreatic Cancer

“This striking relationship between recent-onset diabetes is unique to pancreatic cancer, and is not seen in breast, prostate, and colorectal cancer in the cohort,” said Veronica Wendy Setiawan, PhD, Associate Professor of Preventive Medicine at the Keck School of Medicine of the University of Southern California, and the lead author of this study, in a statement. “Our findings strongly support the hypothesis that recent-onset diabetes is a consequence of pancreatic cancer and that long-standing diabetes is a risk factor for this cancer. Importantly, here we show that the association of recent-onset diabetes with pancreatic cancer is observed in African Americans and Latinos, two understudied minority populations.”

Dr. Setiawan is the corresponding author of this study.

Funding for this study was provided by the National Cancer Institute and the American Cancer Society.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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