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. 2025 Jul 7:S0016-5085(25)05730-0.
doi: 10.1053/j.gastro.2025.06.025. Online ahead of print.

Risk of Pancreatic Cancer in Glycemically Defined New-Onset Diabetes: A Prospective Cohort Study

Suresh T Chari  1 , Bechien Wu  2 , Camden Lopez  3 , Eva Lustigova  2 , Qiaoling Chen  2 , Stephen K Van Den Eeden  4 , Amethyst D Leimpeter  4 , William Fisher  5 , Amy Wood  5 , Ashley S Alexander  6 , John Valenta  6 , Santhi Swaroop Vege  7 , Erin E Carlson  8 , Kari G Rabe  8 , Phil A Hart  9 , Lu Qian  3 , Ying-Qi Zhao  3 , Nadia Yosuf  3 , Lynn Matrisian  10 , Barbara Kenner  11 , Jo Ann Rinaudo  12 , Anirban Maitra  13 , Ziding Feng  3
Affiliations

Risk of Pancreatic Cancer in Glycemically Defined New-Onset Diabetes: A Prospective Cohort Study

Suresh T Chari et al. Gastroenterology. .

Abstract

Background & aims: The increased 3-year incidence of pancreatic cancer after new-onset diabetes observed in retrospective studies needs prospective validation. It is unknown whether incidence varies by race and ethnicity.

Methods: In a prospective, observational study using active real-time surveillance of electronic health records, we identified 18,838 adults 50 years or older with glycemically defined new-onset diabetes (GNOD). In this interim analysis, we report 3-year Kaplan-Meier estimates of the proportion diagnosed with pancreatic cancer after GNOD (absolute incidence [95% CI]) and associated standardized incidence ratio (SIR) by race and ethnicity, overall 3-year incidence of pancreatic cancer adjusting for racial distribution of incident diabetes in the United States, and interval between GNOD and pancreatic cancer diagnosis.

Results: During median follow-up of 2.3 years, 82 pancreatic cancers were diagnosed (60% in men; mean [SD] age, 71 [8] years). The 3-year estimates for the proportion diagnosed with pancreatic cancer and associated SIR by race and ethnicity were as follows: non-Hispanic White patients (n = 6518): 0.84% (95% CI, 0.60%-1.07%) and 6.4 (95% CI, 4.8-8.4); Hispanic patients (n = 5984): 0.40% (95% CI, 0.20%-0.60%) and 4.2 (95% CI, 2.6-6.3); African American patients (n = 2192): 0.37% (95% CI, 0.07%-0.67%) and 2.4 (95% CI, 1.0-5.0), and Asian/Pacific Islander patients (n = 3360): 0.22% (95% CI, 0.06%-0.39%) and 3.0 (95% CI, 1.4-6.0). Overall, race-adjusted 3-year pancreatic cancer incidence was 0.62%. On average, GNOD occurred 8 months before clinical diagnosis (0-4 months in 30.5%, 4-12 months in 31.3%, 12-24 months in 19.5%, and 24-36 months in 18.7%).

Conclusions: GNOD, identifiable in real time using active surveillance of electronic health records, is associated with a high 3-year incidence of pancreatic cancer with marked racial and ethnic differences. Longer-term risk needs further study.

Keywords: AAPI; Asian-American/Pacific Islander; Bias; Black/African American; Disparate; Disparity; Diversity; Equal; Equality; Equity; Gender; HbA(1c); Hispanic/Latinx; Incident Diabetes; Inclusion; Native American/Indigenous/American Indian; Pancreatic Ductal Adenocarcinoma; Parity; Race; Screening; Socioeconomic; Status; Unequal; White/.

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Conflict of interest statement

Conflict of Interest: None of the authors declare any conflict of interest related to the study. Other disclosures unrelated to this study are:

AM: Consulting for Tezcat Biosciences, License on patent to Thrive Earlier Detection, as Exact Sciences Company

STC: Serves on advisory boards of Horizon Therapeutics, Amgen, Olympus Corporation, ClearNote, and Pfizer.

Figures

Figure 1.
Figure 1.
Incidence of pancreatic cancer in the REGARD cohort by racial and ethnic groups depicted as A. observed incidence rate per 1,000 person-years and B. cumulative incidence * Expected incidence is calculated in an age-, sex-, and race/ethnicity-adjusted manner using SEER 2017-2021 incidence rates and the total person-years of follow-up in this study within each demographic category.
Figure 2.
Figure 2.
Kaplan-Meier estimates of distribution of lead time from date of G-NOD to clinical diagnosis of pancreatic cancer Based on Kaplan-Meier estimates of pancreatic cancers diagnosed up to 3-years from G-NOD date
See this image and copyright information in PMC

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