Hyperglycaemia has been identified in patients with pancreatic cancer up to 36 months before cancer diagnosis. Newly diagnosed diabetes after 50 years of age has received attention as a potential marker of undiagnosed pancreatic cancer, with three-year cancer rates ranging from 0.25 per cent to 1.0 per cent.
This cohort study published in JAMA Open, included 851,402 patients aged 50 to 84, who had glycated haemoglobin (HbA1c) measurements between 2010 and 2014. Contemporaneous cohorts were created based on HbA1c thresholds and prior diabetes status.
New cases of pancreatic cancer over a three-year period were measured. The incidence rate of pancreatic cancer was 0.45 (95% CI 0.43-0.49) per 1,000 person-years.
Excluding prior diabetes and new-onset hyperglycaemia based on an HbA1c level of 6.5 per cent, a total of 20,012 patients remained, with 74 of 1,041 pancreatic ductal adenocarcinoma cases (7.1%) from the base cohort included.
The rate of pancreatic cancer was 0.72, 0.83, 0.84 and 2.37 per 1,000 person-years among Asian, non-Hispanic black, Hispanic, and non-Hispanic white patients, respectively.
Among the 1,041 cases, 708 had staging information available, 465 had stage III or IV disease at diagnosis.
Identification of populations at higher risk of pancreatic cancer due to glycaemic parameters should account for racial/ethnic differences.