Risk Factors for Pancreatic Cancer in Patients with New-Onset Diabetes: A Systematic Review and Meta-Analysis

Abstract

(1) Background: Patients with new-onset diabetes (NOD) are at risk of pancreatic ductal adenocarcinoma (PDAC), but the most relevant additional risk factors and clinical characteristics are not well established. (2) Objectives: To compare the risk for PDAC in NOD patients to persons without diabetes. Identify risk factors of PDAC among NOD patients. (3) Methods: Medline, Embase, and Google Scholar were last searched in June 2022 for observational studies on NOD patients and assessing risk factors for developing PDAC. Data were extracted, and Meta-Analysis was performed. Pooled effect sizes with 95% confidence intervals (CI) were estimated with DerSimonian & Laird random effects models. (4) Findings: Twenty-two studies were included, and 576,210 patients with NOD contributed to the analysis, of which 3560 had PDAC. PDAC cases were older than controls by 6.14 years (CI 3.64–8.65, 11 studies). The highest risk of PDAC involved a family history of PDAC (3.78, CI 2.03–7.05, 4 studies), pancreatitis (5.66, CI 2.75–11.66, 9 studies), cholecystitis (2.5, CI 1.4–4.45, 4 studies), weight loss (2.49, CI 1.47–4.22, 4 studies), and high/rapidly increasing glycemia (2.33, CI 1.85–2.95, 4 studies) leading to more insulin use (4.91, CI 1.62–14.86, 5 studies). Smoking (ES 1.20, CI 1.03–1.41, 9 studies) and alcohol (ES 1.23, CI 1.09–1.38, 9 studies) have a smaller effect. (5) Conclusion: Important risk factors for PDAC among NOD patients are age, family history, and gallstones/pancreatitis. Symptoms are weight loss and rapid increase in glycemia. The identified risk factors could be used to develop a diagnostic model to screen NOD patients.

Metastatic Renal Cell Carcinoma to Pancreas: Case Series and Review of the Literature

“…As for PDAC, diabetes mellitus (DM)—and particularly new-onset DM—can be an indicator of possible pancreatic involvement in the evolution of a patient with a history of RCC [ 27 , 28 , 29 ]. Interestingly, among host-related factors, fatty pancreas has been reported as a risk factor for late pancreatic metastases from RCC [ 30 ].…”

Post‐pancreatitis diabetes mellitus is common in chronic pancreatitis and is associated with adverse outcomes

“…However, as opposed to insulin, biguanides (metformin) are shown to promote a survival benefit in PPDM patients 38 . Given that the patients with chronic pancreatitis are at increased risk of developing pancreatic cancer 19,37,39 —especially those with high BMI and diabetes 4 —the proposed antineoplastic properties of metformin might be of an additional benefit to PPDM patients. Although guidelines and recommendations for management of PPDM have been underdeveloped, most experts in the field agree that PPDM needs special consideration for management, including maintained treatment with biguanides in all patients with PPDM irrespective of their requirement for insulin, and avoidance of incretin‐based treatment (acute pancreatitis is a known side‐effect), sulfonylureas (due to their increased risk of inducing hypoglycemia) and sodium‐glucose cotransporter 2 (SGLT2) inhibitors (due to increased risk of diabetic ketoacidosis in patients with absolute insulin deficiency) 16,37,40–42 .…”

Früherkennung des sporadischen Pankreasadenokarzinoms

“…Die Möglichkeiten, d. h. die Kombination aus Risikoscores, innovativen Biomarkern und den neuen KI-Technologien sind vielversprechend und eröffnen eine Perspektive, bei NOD50 + Personen das PK frühzeitig im Tumorstadium IA diagnostizieren zu können [14,15,16,35,36,39,60,61,62] (▶ Abb. 5).…”