Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus

Abstract

Background & aims: Information on the clinical profile of pancreatic cancer (PaC) associated diabetes (DM) is limited. We compared the prevalence and clinical characteristics of DM in subjects with and without PaC.

Methods: We prospectively recruited 512 newly diagnosed PaC cases and 933 controls of similar age, who completed demographic and clinical questionnaires and had fasting blood glucose (FBG) levels measured at recruitment and after pancreaticoduodenectomy (n = 105). Subjects with a FBG level >126 mg/dL or who were on antidiabetic treatment were classified as having DM.

Results: DM was more prevalent (47% vs 7%; P < .001) and predominantly of new onset (<2-year duration) (74% vs 53%; P = .002) among cases compared with controls. Among PaC cases, those with DM (n = 243) were older (68 +/- 10 vs 64 +/- 12 years; P < .001), reported higher usual adult body mass index (30 +/- 6 vs 27 +/- 5 kg/m(2); P < .001), and had a greater frequency of family history of DM (47% vs 31%; P < .001) compared with those without DM (n = 269). After pancreaticoduodenectomy, while DM resolved in 17 of 30 patients (57%) with new-onset DM, its prevalence was unchanged in patients with long-standing DM (n = 11) (P = .009).

Conclusions: PaC is a powerful diabetogenic state; DM associated with PaC is often new-onset, resolves following cancer resection, and appears to be associated with conventional risk factors for DM. New-onset DM in patients with PaC is likely induced by the tumor.

Figure 1

Distribution of fasting blood glucose among pancreatic cancer cases (n=512) and controls (n=933), p<.001 FBG Fasting blood glucose Normal fasting glucose (NFG) [≤99mg/dl (5.5 mmol/L)], Impaired fasting glucose (IFG) [100–125 mg/dl (5.6–6.9)], Diabetes mellitus (DM) [≥126mg/dl (7 mmol/L)] To convert FBG values from mg/dl to mmol/L, multiply by 0.055.

Figure 2

Diabetes mellitus (DM) prevalence after pancreaticoduodenectomy for pancreatic cancer (PaC) New-onset DM (<2 yr duration) Long-standing DM (>2 yr duration) Normal fasting glucose (NFG) [≤99mg/dl (5.5 mmol/L)], Impaired fasting glucose (IFG) [100–125 mg/dl (5.6–6.9)], Diabetes mellitus (DM) [≥126mg/dl (7 mmol/L)] To convert FBG values from mg/dl to mmol/L, multiply by 0.055.