Prevalence of new onset diabetes mellitus among patients with pancreatic ductal adenocarcinoma: a population-based study

Background

Pancreatic ductal adenocarcinoma (PDAC) has remained one of the most serious malignancies and is still a leading cause of cancer-related deaths worldwide. Great attention has been paid to the relationship between diabetes mellitus and PDAC. The aim of our study was to analyse the mutual association of PDAC and diabetes mellitus in the entire population of the Czech Republic within a 5-year period.

Methods

The incidence of PDAC in 2018-2022 was estimated based on the individual population data from the Czech National Cancer Registry. Another data source, the National Registry of Reimbursed Health Services that collects data from health insurance companies, was used to identify individuals recently diagnosed with diabetes mellitus. For the purpose of this study, diagnosis of new-onset of diabetes mellitus was defined as the time of the first prescription of any antidiabetic drug or another related health care service. Subsequently, patients diagnosed with PDAC in 2022 were followed retrospectively to see if they had been diagnosed with diabetes mellitus in the last five years before diagnosis of pancreatic cancer.

Results

In 2022, 2,189 patients aged 60 years or older were diagnosed with pancreatic cancer. New-onset diabetes was observed in 17.4% within five years prior to diagnosis, with the highest occurrence (12.4%) within the last three years. Among patients aged 60-74 years, the respective proportions were 14.4% within three years and 5.7% four to five years prior to pancreatic cancer diagnosis.

Conclusion

The incidence of pancreatic cancer in the Czech Republic is among the highest in Europe. One-fifth of PDAC cases are diagnosed following new-onset diabetes mellitus in patients over sixty. Unintended significant weight loss combined with new-onset diabetes thus must not be overlooked, as these can be early signs of PDAC. An individualised diagnostic work-up should follow without any unnecessary delay.

Note

The study was presented in part, as an abstract and moderated poster, at the 32nd United European Gastroenterology Week, Vienna, October 12-15, 2024 [abstract: UEG Journal, 2024(12), S8: 565-566].

Key Summary

• Summarise the established knowledge on this subject

  • Pancreatic ductal adenocarcinoma (PDAC) is□one of the most lethal□gastrointestinal cancers, with an increasing incidence worldwide.

  • The mutual association between□PDAC and diabetes mellitus has been recognized for decades. While diabetes mellitus can be a risk factor for pancreatic cancer, new-onset diabetes□often serves as□an early sign of PDAC.

  • Different types of diabetes mellitus□are□associated with PDAC. Type 2 diabetes is the most common (characterized by increased insulin secretion and receptor resistance). Secondary diabetes mellitus in non-malignant pancreatic diseases (e.g., chronic pancreatitis) involves a reduction of islet-cell mass, leading to decreased insulin secretion□but□normal insulin sensitivity.□Type 3c diabetes associated with PDAC is considered□a paraneoplastic syndrome, characterized by decreased insulin secretion and increased insulin resistance.□

• What are the significant and/or new findings of this study?

  • Our study was based on data from Czech national healthcare registries (2018– 2022).

  • The age-standardized incidence rate of PDAC in the Czech Republic was 24.6 per 100,000 population in 2023.

  • In 2022, 2,189 patients over the age of 60 were diagnosed with PDAC. New-onset diabetes mellitus was recorded in 12.4% of patients within three years□prior to their□cancer diagnosis.

  • Specifically, among□patients aged 60–74 years, this proportion was 14.4% (three years prior to diagnosis),□reaching a total of□20.1% over a five-year period.

  • Unintended significant weight loss combined with new-onset diabetes must not be overlooked, as these can be early signs of PDAC.

  • An individualized diagnostic work-up should follow without□unnecessary delay