New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer

Abstract

Summary Pancreatic cancer has a dismal prognosis as cancer-specific symptoms occur only at an advanced stage. If the cancer is to be discovered early, it will have to be done in asymptomatic individuals. Since the incidence of pancreatic cancer is low, screening for asymptomatic cancer in the general population will not be feasible. Screening will have to be restricted to subjects at high risk for pancreatic cancer. The proportion of pancreatic cancer patients who also have hyperglycemia or diabetes has previously been under appreciated; new data show that up to 80% are either hyperglycemic or diabetic and this can be evident in the pre-symptomatic phase. Diabetes improves following pancreatic cancer resection suggesting that diabetes is caused by the cancer. Conversely, older subjects with new-onset diabetes have an approximately 8 fold higher risk of having pancreatic cancer compared to the general population. Recognition of new-onset diabetes as an early manifestation of pancreatic cancer could lead to diagnosis of asymptomatic, early stage pancreatic cancer. However, primary type 2 diabetes is common and pancreatic cancer is relatively uncommon in the general population and the two forms of diabetes are clinically indistinguishable. The success of the strategy to use new-onset hyperglycemia and diabetes as a screening tool to identify subjects with a high likelihood of having asymptomatic pancreatic cancer will depend largely on our ability to differentiate pancreatic cancer-associated diabetes from the more common type 2 diabetes using a (serologic) biomarker.