An association between diabetes mellitus (DM) and pancreatic ductal adenocarcinoma (PDA) has been recognized for more than half a century,1 yet diagnostic and therapeutic applications of this relationship remain limited. Increasing epidemiologic evidence suggests that patients with DM are at significantly greater risk for PDA. In a population-based study of 2122 patients with DM, the incidence of pancreatic cancer within 3 years of DM diagnosis was nearly 8 times that of the general nondiabetic population.2
Although long-standing DM may be a risk factor for developing PDA, new-onset DM may, conversely, be a manifestation of the cancer. Patients with PDA are significantly more likely to have new-onset DM (<2-year duration) than noncancer controls3 and to have a significantly higher prevalence of DM than patients with other types of cancer, such as lung, breast, prostate, and colorectal cancers, and patients without cancer.4
Moreover, dysglycemia itself may have a negative impact on outcomes of hospitalized patients with cancer in terms of infection, mortality, length of stay, and toxicities. The risk of cancer death (from stomach, liver, lung cancers) has been noted to be significantly higher among those with a high fasting plasma glucose (≥5.6 mmol/L), after adjustment for potentially confounding factors.5
This article directly evaluates the relationship between glycosylated hemoglobin (HbA1c), an objective and quantifiable measure of glucose intolerance, and pancreatic cancer in patients without a history of chronic DM presenting with suspected PDA. Specifically, this article examines the potential utility of HbA1c level to discriminate between benign pancreatic disease (BPD) and stages of PDA, and investigates the effect of impaired glucose tolerance on patient survival outcomes.
Funding was received from National Cancer Institutes, P30 CA006973, and the Claudio X. Gonzalez Family Foundation. The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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