medwireNews: Chinese people with new-onset type 2 diabetes have a significantly increased risk for pancreatic cancer relative to the general population, particularly when they are diagnosed at a young age, study findings indicate.
Yan Shi (Shanghai Clinical Research Center for Aging and Medicine, China) and co-investigators say: “Efforts toward early and close follow-up programs, especially in individuals with young-onset [type 2 diabetes], and the improvement of glucose control might represent effective strategies for improving the detection and results of treatment of pancreatic cancer.”
Their longitudinal cohort study included data for 428,362 people (mean age 63.8 years, 48% men) with new-onset type 2 diabetes from the Shanghai Standardized Diabetes Management System.
Of these, 1056 developed pancreatic cancer during 8 consecutive years of follow-up, giving an overall pancreatic cancer annual incidence rate of 55.28 cases per 100,000 person–years. The rates were 59.61 and 51.38 cases per 100,000 person–years in men and women, respectively.
By comparison, pancreatic cancer incidence in the general population of Shanghai was 20.94 cases per 100, 000 person–years overall, giving a standardized incidence ratio (SIR) of 1.54 among the people with diabetes. The SIR was also 1.54 in men and was slightly higher, at 1.57, in women.
The researchers found that pancreatic cancer incidence increased significantly with age, from 17.62 cases per 100,000 person–years among people with diabetes aged 20−54 years to 120.45 per 100,000 person–years in those aged 75 years and older.
However, the risk for pancreatic cancer relative to the general population was highest in the youngest people with diabetes, at an SIR of 5.73 for those 20 to 54 years of age. In people aged 55−64 years, 65−74 years, and 75 years and older, the SIRs were a respective 1.91, 1.46, and 1.24.
Shi et al therefore say: “Young-onset [type 2 diabetes] might be an important risk factor for pancreatic cancer and this suggests that close follow-up program for pancreatic cancer should be implemented in this group with early onset of [type 2 diabetes].”
The team also reports that new-onset type 2 diabetes was associated with a significantly increased risk for pancreatic cancer at any diabetes duration, but the highest SIRs were observed among people with a diabetes duration of 1 year or less (SIR=1.73), and among those with a diabetes duration of 6 years or longer (SIRs=1.73–1.79).
Fasting blood glucose (FBG) levels were another factor that impacted pancreatic cancer risk. Individuals with new-onset type 2 diabetes and an FBG of at least 10.0 mmol/L (180.2 m/dL) were 2.35 times more likely to develop pancreatic cancer than those with an FBG level below 6.0 mmol/L (108.2 mg/dL).
Taking these additional variables into account, the researchers found that people aged 75 years or older with an FBG level of 10.0 mmol/L or higher had the greatest absolute risk for pancreatic cancer, at an incidence of 250.25 cases per 100,000 person–years, while those aged 20−54 years with the same high FBG level had the highest relative pancreatic cancer risk, at an SIR of 16.73.
Using Mendelian randomization analysis to assess causal relationships, Shi and colleagues calculated that type 2 diabetes may be associated with a 24% increased risk for pancreatic cancer in the east Asian population.
The authors conclude in The Lancet Regional Health – Western Pacific: “The high prevalence and accelerated epidemic of [type 2 diabetes] has become a major public health challenge and undoubtedly increases the risk of pancreatic cancer.”
They add: “Risk reducing activities could be expected to lead to a significant reduction of this cancer, particularly in China with its very large population.”
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Lancet Reg Health West Pac 2022; doi:10.1016/j.lanwpc.2022.100596