Elsevier

Pancreatology

Volume 12, Issue 2, March–April 2012, Pages 156-161
Pancreatology

Original article
New-onset diabetes in pancreatic cancer: A study in the primary care setting

https://doi.org/10.1016/j.pan.2012.02.003Get rights and content

Abstract

Background

Onset of diabetes mellitus (DM) is often first noted by primary care physicians. New-onset DM (duration <36 months before PaC diagnosis) can be a harbinger of pancreatic cancer (PaC). However, its clinical significance remains unclear.

Methods

To determine the prevalence, onset, and delay in diagnosis of DM in PaC patients in the primary care setting, we retrospectively reviewed the records of consecutive patients followed in Mayo Clinic’s primary care clinics (at least one visit in the preceding 2 years) from 1995 to 2009 who were eventually diagnosed with PaC. Onset of DM was the first date the fasting blood glucose was ≥126 mg/dl.

Results

Of the 111 PaC patients (59 male, median age 74 years), 52 (47%) had DM of whom 30 (58%) had new-onset DM. Among the 30 with new-onset DM, 24 (80%) were asymptomatic (no cancer-specific symptoms), at DM onset. In these 24 patients, median duration of DM prior to PaC diagnosis was 6.5 (0.5–35) months, and median delay between onset and physician diagnosis of DM was 2.5 (0.25–14) months, which decreased from 8.8 (3.5–14) months in patients with DM onset between 1995 and 1999 to 0 (0–2) months, in patients with DM onset between 2004 and 2009. However, the proportion of patients with undiagnosed DM (∼33%) remained unchanged.

Conclusions

Diabetes is very common (∼50%) in PaC. In over a fifth of PaC, the onset of DM occurs when the cancer is asymptomatic, providing a potential window-of-opportunity to diagnose early PaC. However, nearly a third of new-onset DM in PaC remains undiagnosed.

Section snippets

Background

The association between diabetes mellitus (DM) and pancreatic cancer (PaC) has been known for over a century. It is now well understood that while long-standing diabetes is an etiologic factor for pancreatic cancer, new-onset diabetes can be a manifestation of the cancer [1]. A recent meta-analysis of 17 case–control and 19 cohort (or nested case–control) studies published between 1966 and 2005 reported that the combined age- and sex-adjusted odds ratio (OR) for PaC associated with DM was 1.82

Methods

This study was approved by the Mayo Foundation Institutional Review Board.

Patient demographics (Table 1)

The cohort of 111 PaC patients (59 males, 52 females) had a median age of 74 years (range 38–100 years). A prior or current history of smoking was noted in 61% of patients. Having at least one family member with DM was noted for 42% of patients. The sub-group of patients with DM (n = 52) comprised 23 females and 29 males with a median age of 74.5 years (range 39–90 years); in addition, there was a history of smoking in 64% and a positive family history of DM in 46%.

Cancer-specific symptoms (Table 2)

Cancer-specific symptoms were

Discussion

In this retrospective study of 111 consecutive PaC patients followed in the Mayo Clinic primary care clinics, we show that the prevalence of DM is high (47%). The majority (58%) of DM in PaC is new-onset (<36 months in duration). Among 30 PaC subjects with new-onset DM, 24 (80%) had no symptoms of PaC when they first met criteria for DM. The diagnosis of DM was made at its onset in only 5/24 (21%) patients with DM and asymptomatic PaC. In fact, in nearly one-fourth (6/24) of patients, the

Conflict of interest/disclosure

None declared.

Grant support

Dr. Chari’s research was funded by grants from NIH (R01 CA 100685) and the Mayo Clinic SPORE in Pancreatic Cancer (P50 CA 102701).

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