Onset or Rapid Worsening of Diabetes May Indicate Pancreatic Cancer
A complex association between type 2 diabetes and pancreatic cancer has been established.
The onset of diabetes and the rapid worsening of existing diabetes requiring more aggressive therapy could indicate early, concealed pancreatic cancer. These findings were presented at the 2017 European Cancer Congress.1
This study examined data from almost 1 million patients with type 2 diabetes in Lombardy, Italy, and Belgium. These patients had recorded diagnoses of pancreatic cancer, with half of the cases occurring within 1 year of type 2 diabetes diagnoses.
"In Belgium 25% of cases were diagnosed within 90 days and in Lombardy it was 18%. After the first year, the proportion of diagnosed pancreatic cancers dropped dramatically," explained Alice Koechlin, MS, from the International Prevention Research Institute, Lyon, France, and co-author of the study.
The risk of finding pancreatic cancer during the initial 3 months after a patient's first prescription for incretins was 3.5-fold higher than that for patients who were able to maintain use of oral antidiabetes drugs. Incretins are metabolic hormones that cause the pancreas to generate more insulin.
This risk decreased incrementally over time: risk was 2.3-fold in the 3 to 6 month range, 2-fold in 6 to 12 months, and 1.7-fold after 12 months.
In patients whose type 2 diabetes was already managed with oral antidiabetes medications, the switch to incretins or insulin occurred faster in those who were later found to have pancreatic cancer. Also, worsening diabetes necessitating a change to more aggressive treatment with injections of insulin correlated with a 7-fold higher risk of finding pancreatic cancer.
In an analysis of prescription data, researchers identified 456,311 patients with type 2 diabetes between 2008 and 2012 in Italy and 368,377 patients with type 2 diabetes between 2008 and 2013 in Belgium. This study linked data to pancreatic cancer cases in the Belgian Cancer Registry and hospital discharge databases in Italy.
During this time, 1,872 cases of pancreatic cancer occurred in Italy, and 885 occurred in Belgium.
Although an association between type 2 diabetes and pancreatic cancer has been established, the relationship between the two is complex, explained Koechlin. Incretin therapies are believed to promote the occurrence of pancreatic cancer because of their stimulating effects on the pancreas. However, pancreatic cancer is known to cause diabetes.
These results indicate that incretins are frequently prescribed to patients with diabetes caused by undiagnosed pancreatic cancer. While it can appear as though intake of incretin causes pancreatic cancer, these results suggest that pancreatic cancer causes a worsening of diabetes.
Further research is needed to determine whether a patient has undiagnosed pancreatic cancer.
"There is currently no good, noninvasive method for detecting pancreatic cancer that is not yet showing any visible signs or symptoms,” concluded Koechlin.
“We hope that our results will encourage the search for blood markers indicating the presence of pancreatic cancer, which could guide decisions to perform a confirmation examination like endoscopy."
1. Autier P, Bot M, Boyle P, et al. Early detection of pancreatic cancer among diabetic patients: results from prescription database analyses. Paper presented at: European Cancer Congress 2017; January 27-30, 2017; Amsterdam, Netherlands. Abstract 540