An analysis of the global burden of pancreatic cancer attributable to High fasting plasma glucose: 1990– 2021

Background: Pancreatic cancer (PC), a highly aggressive malignancy with poor prognosis, is frequently diagnosed at advanced stages. High fasting plasma glucose (HFPG), a key metabolic risk factor, significantly contributes to pancreatic cancer mortality and disability-adjusted life years (DALYs). This study aimed to quantify the global burden of pancreatic cancer attributable to HFPG from 1990 to 2021 and inform targeted prevention strategies. Methods: We extracted data on the burden of pancreatic cancer attributable to high fasting blood glucose from 1990 to 2021 from the Global Burden of Disease (GBD) 2021 database. We characterized this burden across different ages, sexes, age groups, Socio-demographic Index (SDI) regions, and countries. To illustrate temporal trends in the pancreatic cancer burden, we computed the estimated annual percentage change (EAPC) for the period 1990–2021. Decomposition analysis was used to identify drivers of changes in burden, while inequality analysis assessed disparities across SDI levels. Results: Globally, the ASMR and ASDR of PC related to HFPG showed an upward trend between 1990 and 2021, and the absolute number of deaths and DALYs cases increased more than threefold. High SDI regions exhibit a higher burden due to a higher number of HFPG patients, population growth, and aging, while low SDI regions face higher EAPCs due to limited resources. Moreover, this inequality has become even more pronounced. Men are more susceptible in all age groups. There are significant differences in burden management among countries, with some low SDI countries showing better performance than high SDI countries. Conclusion: It was found that PC attributable to HFPG was generally on the rise from 1990 to 2021 around the world. The age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) for PC linked to HFPG increased with higher SDI. Older and middle-aged populations bore the heaviest burden, with males carrying a greater PC burden than females. Population growth and epidemiological shifts drove this increase, while SDI-related inequalities are worsening. Targeted interventions addressing metabolic risks and healthcare access are warranted.