Association between unstable diabetes mellitus and risk of pancreatic cancer.

Pancreatic cancer Record-linkage Risk Unstable diabetes mellitus

Journal

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
ISSN: 1424-3911
Titre abrégé: Pancreatology
Pays: Switzerland
ID NLM: 100966936

Informations de publication

Date de publication:
17 Nov 2023
Historique:
received: 22 06 2023
revised: 29 10 2023
accepted: 13 11 2023
medline: 25 11 2023
pubmed: 25 11 2023
entrez: 24 11 2023
Statut: aheadofprint

Résumé

Deterioration of glycaemic control in people with long-standing diabetes mellitus (diabetes) may be a possible indicator of pancreatic cancer. However, the magnitude of the association between diabetes deterioration and pancreatic cancer has received little attention. We conducted a matched cohort study, nested within a population-based cohort of Australian women with diabetes. Women with unstable diabetes, defined as a change in medication after a 2-year period of stable medication use, were matched by birth year to those with stable diabetes, in a 1:4 ratio. We used flexible parametric survival models to estimate hazard ratios (HRs) and 95% confidence intervals (CI). We included 134,954 and 539,789 women in the unstable and stable diabetes cohorts, respectively (mean age 68 years). In total, 1,315 pancreatic cancers were diagnosed. Deterioration of stable diabetes was associated with a 2.5-fold increased risk of pancreatic cancer (HR 2.55; 95% CI 2.29-2.85). The risk was particularly high within the first year after diabetes deteriorated. HRs at 3 months, 6 months and 1 year were: 5.76 (95% CI 4.72-7.04); 4.56 (95% CI 3.81-5.46); and 3.33 (95% CI 2.86-3.89), respectively. The risk was no longer significantly different after 7 years. Deterioration in glycaemic control in people with previously stable diabetes may be an indicator of pancreatic cancer, suggesting investigations of the pancreas may be appropriate. The weaker longer-term (3-7 years) association between diabetes deterioration and pancreatic cancer may indicate that poor glycaemic control can be a risk factor for pancreatic cancer.

Sections du résumé

BACKGROUND BACKGROUND
Deterioration of glycaemic control in people with long-standing diabetes mellitus (diabetes) may be a possible indicator of pancreatic cancer. However, the magnitude of the association between diabetes deterioration and pancreatic cancer has received little attention.
METHODS METHODS
We conducted a matched cohort study, nested within a population-based cohort of Australian women with diabetes. Women with unstable diabetes, defined as a change in medication after a 2-year period of stable medication use, were matched by birth year to those with stable diabetes, in a 1:4 ratio. We used flexible parametric survival models to estimate hazard ratios (HRs) and 95% confidence intervals (CI).
RESULTS RESULTS
We included 134,954 and 539,789 women in the unstable and stable diabetes cohorts, respectively (mean age 68 years). In total, 1,315 pancreatic cancers were diagnosed. Deterioration of stable diabetes was associated with a 2.5-fold increased risk of pancreatic cancer (HR 2.55; 95% CI 2.29-2.85). The risk was particularly high within the first year after diabetes deteriorated. HRs at 3 months, 6 months and 1 year were: 5.76 (95% CI 4.72-7.04); 4.56 (95% CI 3.81-5.46); and 3.33 (95% CI 2.86-3.89), respectively. The risk was no longer significantly different after 7 years.
CONCLUSIONS CONCLUSIONS
Deterioration in glycaemic control in people with previously stable diabetes may be an indicator of pancreatic cancer, suggesting investigations of the pancreas may be appropriate. The weaker longer-term (3-7 years) association between diabetes deterioration and pancreatic cancer may indicate that poor glycaemic control can be a risk factor for pancreatic cancer.

Identifiants

DOI: 10.1016/j.pan.2023.11.009 PMID: 38000983
pubmed: 38000983
pii: S1424-3903(23)01846-X
doi: 10.1016/j.pan.2023.11.009
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Auteurs

Sitwat Ali (S)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia.

Michael Coory (M)

Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.

Peter Donovan (P)

Royal Brisbane and Women's Hospital, Australia; Faculty of Medicine, The University of Queensland, Australia.

Renhua Na (R)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.

Nirmala Pandeya (N)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.

Sallie-Anne Pearson (SA)

School of Population Health, UNSW, Sydney, NSW, Australia.

Katrina Spilsbury (K)

Centre Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.

Louise M Stewart (LM)

School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.

Bridie Thompson (B)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.

Karen Tuesley (K)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia.

Mary Waterhouse (M)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.

Penelope M Webb (PM)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia.

Susan J Jordan (SJ)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia.

Rachel E Neale (RE)

Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia. Electronic address: Rachel.neale@qimrberghofer.edu.au.

Classifications MeSH