The association between diabetes mellitus of different durations and risk of pancreatic cancer: an Australian national data-linkage study in women. (December 2022)

• Record Type: Journal Article
• Authors: Ali, Sitwat; Na, Renhua; Tuesley, Karen; Spilsbury, Katrina; Stewart, Louise M.; Coory, Michael; Webb, Penelope M.; Donovan, Peter; Pearson, Sallie-Anne; Jordan, Susan J.; Neale, Rachel E.
• Is Part Of: Cancer epidemiology. Volume 81(2022)
• Publication Date: 2022-12
• Subjects: Pancreatic cancer -- Diabetes mellitus -- Risk -- Duration -- Record-linkage; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2022.102266
• Languages: English
• ISSNs: 1877-7821

Abstract

Abstract: Aims: The bidirectional association between diabetes mellitus (DM) and pancreatic cancer (PC) is established; however, the strength of association between duration of DM and risk of PC needs further investigation. Methods: We conducted a case-control study nested within a population-based cohort of Australian women established using record linkage. Women diagnosed with PC from July 2007 to December 2013, were matched to five controls based on age and state of residence. DM was defined according to prescription of anti-diabetic medication from administrative prescription data. We used conditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI), adjusted for area-level socioeconomic status, rurality of residence, weighted comorbidity score, and predicted probability of obesity. Results: The analyses included 7, 267 cases and 35, 978 controls. The mean age at the time of DM diagnosis was 71 years whereas the mean age at the time of diagnosis of PC was 76 years. A history of DM of any duration was associated with a 2-fold increase in risk of PC (OR=2.12; 95%CI:1.96–2.29) compared to having no history of DM. The risk decreased with increasing duration of DM. The highest risk was in those who had recent-onset DM (OR=8.08; 95%CI:6.88–9.50 for <12 months of DM), but the risk remained elevated with ≥5 years of DM (OR=1.40; 95%CI:1.27–1.55). Conclusion: The markedly increased risk of PC in those with recent-onset DM emphasises the need for further research to distinguish patients for whom new-onset DM is a manifestation of PC from those with type-2 DM. The elevated risk associated with long-standing DM suggests that preventing DM may contribute to a reduction in the incidence of PC. Highlights: There is limited data about the association between pancreatic cancer (PC) and diabetes mellitus (DM) of different durations, particularly DM of very short duration (<3 months). We found a marked difference in risk of PC according to duration of DM with extremely high risk for DM of <12 months duration. The associations between PC and DM of duration <3 months and 3 to <6 months were particularly strong; these could not be explained by detection bias. The elevated risk of PC was evident even with DM of 10 or more years. Differentiating high-risk new-onset DM secondary to PC from those with type 2 DM will provide a potential avenue for early detection of PC.