New-Onset Diabetes, Longitudinal Trends in Metabolic Markers, and Risk of Pancreatic Cancer in a Heterogeneous Population
Open accessAbstract
Background & aims Observational studies of predominantly white populations have found new-onset diabetes to be associated with increased risk of pancreatic cancer. We sought to determine whether this relationship applies to other races or ethnicities and to identify metabolic profiles associated with increased risk of pancreatic cancer. Methods We conducted a population-based cohort study of Asian, black, Hispanic and white patients from Kaiser Permanente Southern California from 2006 through 2016 (n = 1,499,627). Patients with diabetes were identified based on glucose and hemoglobin A1c (HbA1c) measurements. We used Cox regression to assess the relationship between diabetes status and duration and pancreatic cancer. For patients with recent diagnoses of diabetes (1 year or less) we compared longitudinal changes in glucose, HbA1c, and weight, from time of diabetes diagnosis through 3 years prior to the diagnosis, in patients with vs without pancreatic cancer. Results We identified 2,002 incident cases of pancreatic cancer from nearly 7.5 million person-years of follow-up. Compared to patients without diabetes, individuals who received a recent diagnosis of diabetes had an almost 7-fold increase in risk of pancreatic cancer (relative risk, 6.91; 95% CI, 5.76-8.30). Among patients with a recent diagnosis of diabetes, those who developed pancreatic cancer had more rapid increases in levels of glucose (Δslope: cases, 37.47 mg/dL vs non-cases, 27.68 mg/dL) and HbA1c (Δslope: cases, 1.39% vs non-cases, 0.86%) in the month preceding the diagnosis of diabetes, and subtle weight loss in the prior years (slope: cases -0.18 kg/interval vs non-cases 0.33 kg/interval). These longitudinal changes in markers of metabolism were stronger for specific race and ethnic groups. Conclusions In a study of a large ethnically diverse population, we found risk of pancreatic cancer to be increased among patients with a diagnosis of diabetes in the past year among different races and ethnicities. Weight loss and rapid development of poor glycemic control were associated with increased risk of pancreatic cancer in multiple races.
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Several studies show that the probability PDAC development can be further increased by including additional factors such as weight change, ethnicity, and lifestyle factors that are commonly contained in electronic medical records.
“Of note, several studies show that the probability PDAC development can be further increased by including additional factors such as weight change, ethnicity, and lifestyle factors that are commonly contained in electronic medical records.171–178”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [173]
The Discussion (page not provided) reports that weight loss predicted pancreatic cancer risk in earlier models and suggests incorporating race/ethnicity-specific trends into future risk calculations. The Methods record smoking and alcohol use, but this paper does not show that adding lifestyle factors improves prediction, or test the combined factors as a prediction model. (LLM, conf=0.84)
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Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review
Kenner, B., Chari, S. T., Kelsen, D., Klimstra, D. S., Pandol, S. J., Rosenthal, M., Rustgi, A. K., Taylor, J. A., Yala, A., Abul-Husn, N., et al. (2021) · Pancreas · doi:10.1097/mpa.0000000000001762 · Cited by 158 · see citing works
Self-citation
- Authors
- Huang, B. Z., Pandol, S. J., Jeon, C. Y., Chari, S. T., Sugar, C. A., Chao, C. R., Zhang, Z.-F., Wu, B. U., & Setiawan, V. W.
- Affiliations
- University of Southern California (US)
- Cedars-Sinai Medical Center (US)
- Mayo Clinic (US)
- University of California, Los Angeles (US)
- Kaiser Permanente (US)
- Corresponding author
- Huang, Brian Z.
- ORCID
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 18
- Issue
- 8
- Pages
- 1812-1821.e7
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC7269863
- OpenAlex
- W2992927504
- Cited by
- 87
- References
- 4
- Citations by year
- 2026: 8 · 2025: 21 · 2024: 14 · 2023: 9 · 2022: 15 · 2021: 16 · 2020: 4
- FWCI
- 3.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Cancer Institute
- American Cancer Society
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- new-onset diabetes, pancreatic cancer risk, glycemic control, HbA1c, blood glucose, weight loss, racial and ethnic differences, metabolic biomarkers, diabetes duration, Asian patients, Black patients, Hispanic patients, Caucasian patients
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Pancreatic Neoplasms, Cohort Studies, White People
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