Prompt identification of new-onset diabetes may aid early detection of pancreatic cancer
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Key takeaways:
- Glycemic evidence of new-onset diabetes was linked with increased risk for pancreatic cancer, especially in non-Hispanic white patients.
- Delayed diagnosis leads to a “significant underestimation” of cancer risk.
WASHINGTON — An algorithm that uses electronic health record parameters identified glycemic evidence of new-onset diabetes in real time, which could lead to earlier detection of pancreatic ductal adenocarcinoma, according to researchers.
“In retrospective studies, new-onset diabetes has been associated with a higher risk for pancreatic cancer,” Suresh T. Chari, MD, professor in the department of gastroenterology, hepatology and nutrition at The University of Texas MD Anderson Cancer Center, told Healio. “But maximum risk — approximately 85% over 3 years — is seen when diabetes is identified by abnormal lab values rather than physician diagnosis.
“Our goals were to do a prospective study to determine if it is possible at an institution level to identify diabetes at its glycemic onset, confirm the high risk of pancreatic cancer noted in retrospective studies, determine the interval between diabetes detection and cancer diagnosis, and look at delay in diabetes identification on risk for pancreatic cancer.”
Between September 2018 and May 2022, Chari and colleagues identified 18,944 individuals (mean age, 63.1 years; 51% men) from the Recent Elevation in Glucose and Recent Diabetes (REGARD) cohort with glycemic evidence of new-onset diabetes, defined as at least 6.5% elevation in glycated hemoglobin or blood glucose values meeting American Diabetes Association criteria for diabetes, with confirmed lack of elevations or treatment for diabetes in the previous 18 months.
Researchers developed an algorithm using these parameters, obtained via electronic medical records from four major U.S. health care systems, for real-time identification of diabetes at glycemic onset.
According to results presented at Digestive Disease Week, 82 patients (0.43%; mean age, 69.8 years; 59.8% men) received a diagnosis of pancreatic ductal adenocarcinoma (PDAC) during a median follow-up of 2.3 years, with a standardized incidence ratio for PDAC of 8.2 (95% CI, 5.8-10.7) in non-Hispanic whites (n = 6,567) and 3.1 (95% CI, 2.2-4.4) among remaining patients (n = 12,377). Researchers reported that the risk was “significantly lower” among Hispanic and African American patients compared with non-Hispanic white patients.
Further, 65% of individuals with PDAC were diagnosed more than 4 months after they were identified with glycemic evidence of new-onset diabetes. A 6-month delay in new-onset diabetes diagnosis leads to a “significant underestimation” of PDAC risk, Chari noted, from 4.9- to 3.2-fold (difference = 1.8-fold; 95% CI, 0.96-2.54).
“We believe that our study results warrant development of strategies for early detection of pancreatic cancer in glycemically defined new-onset diabetes,” Chari told Healio. “Imaging studies currently don’t pick up cancer consistently starting a few months before clinical diagnosis. There is hope that AI-assisted CT scans can fill this need.”
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Chari S, et al. The REGARDS study: A prospective study of risk of pancreatic ductal adenocarcinoma in glycemically defined new-onset diabetes ascertained by algorithm based passive surveillance of electronic health records. Presented at: Digestive Disease Week; May 18-21, 2024; Washington (hybrid).
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