TRADITIONAL DIABETES RISK FACTORS IN PANCREATIC CANCER ASSOCIATED DIABETES (PACDM): A PROSPECTIVE STUDY OF 512 PATIENTS

Background/Aims: A common clinical axiom is that new-onset diabetes (DM) in a lean patient without parental history of DM should raise suspicion for pancreatic cancer (PaC). However, the prevalence of traditional risk factors for type 2 DM in PaCDM is not well established. In a prospectively collected cohort of PaC cases, we investigated clinical characteristics of PaC patients with and without DM. Methods: Newly diagnosed PaC patients (n = 512) were prospectively recruited to the Mayo Pancreas Cancer SPORE registry and provided detailed demographic and clinical data through a questionnaire and had fasting blood glucose (FBG) measurement within 30 days of diagnosis. Patients were classified as having DM (FBG ≥ 126 mg/dl or on anti-diabetic treatment), impaired fasting glucose (IFG) (FBG 100-125 mg/dl) or normal FG (NFG) (≤99 mg/dl). Results: Compared to PaC patients without DM (n = 269, 53%), PaCDM patients (n = 243, 47%) were older (68 ± 10 vs. 64 ± 12 years, p < 0.001) and reported a higher premorbid BMI (30 ± 6 vs. 27 ± 5, p < 0.001) and BMI at diagnosis (26 ± 5 vs. 25 ± 5, p = 0.003). Premorbid obesity (36% vs. 24%, p=0.003) and parental history of DM (47% vs. 31 %, p < 0.001) were also more common in PaCDM versus PaC without DM. Tumor location (% head: 72% vs. 66%, p = 0.2), stage (stage I/II: 47% vs. 43%, p = 0.2), and median survival (259 vs. 270 days, p = 0.9) were not significantly different in PaC with and without DM respectively. In multivariate analyses, age (OR 1.04, 95% CI 1.02, 1.06), BMI (OR 1.09, 95% CI 1.05, 1.14), and parental history of DM (OR 1.93, 95% CI 1.3, 2.86) were independent predictors of PaCDM. Conclusions: Traditional type 2 DM risk factors are also associated with PaCDM. Screening for PaC among new-onset DM will require further definition of a higher risk group based on a specific PaC biomarker.