New-onset diabetes was associated with pancreatic cancer, according to results of a prospective study published in Gastroenterology.
All patients with no history of prediabetes or diabetes meeting the screening criteria for pancreatic cancer (N=100) at Beth Israel Deaconess Medical Center and Harvard Medical School were enrolled in this study between 2019 and 2020. Patients were assessed for diabetes status and underwent endoscopic ultrasound.
Patients were aged mean 60.6 (range, 41-84) years, 74% were women, 91% were White, and average BMI was 28.6 (range, 18.3-51.9) kg/m2.
The patients reported a history of hereditary breast and ovarian cancer syndrome (41%), familial pancreatic cancer (40%), Lynch syndrome (8%), ataxia telangiectasia pathogenic variant (5%), familial atypical multiple mole melanoma syndrome (4%), and hereditary pancreatitis (2%).
Abnormal fasting blood sugar was observed among 21 patients. In total, 20 patients were diagnosed as prediabetic (blood sugar 100-125 mg/dL) and 1 as having new-onset diabetes (blood sugar ≥126 mg/dL).
At endoscopy, 53% of patients presented with low-risk lesions, 35% with moderate-risk lesions, and 2% with high-risk lesions. The high-risk lesions included progressive pancreatic duct dilation and a 1.2 cm pancreatic duct adenocarcinoma.
A total of 17 patients underwent fine needle sampling and researchers found cystic (n=13), solid (n=3), and pancreatic duct stricture (n=1) lesions.
One of the high-risk patients had high-grade dysplasia. This patient underwent distal pancreatectomy and was found to have main-duct intraductal papillary mucinous neoplasm without cancer. The second high-risk patient was found to have adenocarcinoma and was receiving neoadjuvant chemoradiation at the time of study publication. This patient was the same individual who had been diagnosed with new-onset diabetes.
This study was limited by the small number of patients included in the study cohort.
The study authors concluded that new-onset diabetes was associated with pancreatic cancer. There was no evidence to suggest there was an association between borderline hyperglycemia and pancreatic neoplasia.
Shah I, Wadhwa V, Bilal M, Germansky KA, Sawhney MS. Prospective assessment for prediabetes and new-onset diabetes in high-risk individuals undergoing pancreatic cancer screening. Gastroenterol. Published online June 24, 2021. doi:10.1053/j.gastro.2021.06.055