High Blood Sugar Increases Pancreatic Cancer Rate

High fasting glucose levels may increase the risk of pancreatic cancer, according to a study recently published in The Journal of Clinical Endocrinology & Metabolism.

Researchers led by Cheol-Young Park, MD, PhD, of Kangbuk Samsung Hospital in Seoul, Korea, point out that a recent case-control study showed that patients diagnosed with pancreatic cancer had hyperglycemia for 36 to 60 months prior to diagnosis, but whether the risk of pancreatic cancer is different according to glucose levels in the general population was not clear. “Therefore, we used prospectively collected national cohort data in Korea to investigate the association between fasting glucose levels and pancreatic cancer risk in the general population,” the authors write.

“Diabetes is one of the established risk factors for pancreatic cancer,” Park says. “When we evaluated the pancreatic cancer incidence according to fasting glucose levels using a national cohort database, we found the number of pancreatic cancer cases rose as fasting glucose levels increased. This was true in people who had diabetes as well as those who did not.”

“The incidence of pancreatic cancer increased significantly with increasing fasting blood glucose levels even after adjusting for age, sex, smoking, drinking, exercise, body mass index and diabetes duration.”

In this nationwide study, researchers evaluated pancreatic cancer incidence in Korea according to blood sugar levels using a national cohort database of more than 25 million patients who had participated in a preventive health check-up between 2009 and 2013 . They found that as blood sugar levels rose, the rate of pancreatic cancer significantly increased not only in diabetic populations, but also in those with prediabetes or normal range of blood sugar levels. “The risk of pancreatic cancer increased continuously with elevating fasting glucose levels,” the authors write. “The incidence of pancreatic cancer increased significantly with increasing fasting blood glucose levels even after adjusting for age, sex, smoking, drinking, exercise, body mass index and diabetes duration.”

The number of patients with diabetes in Korea has risen from 6% to 10% in the past 10 years, according to the authors, and early detection of hyperglycemia could lower the risk of pancreatic cancer.  “Therefore, efforts made toward early detection of hyperglycemia and lifestyle modification to improve glucose profile may provide a practical strategy to reduce the increasing risk of pancreatic cancer,” the authors write.

This study has several strengths, including its prospective nature with a large national population, specific fasting glucose category, and adjustment for well-known confounding risk factors for pancreatic cancer. However, the authors note a few limitations as well: the duration of diabetes could not be underestimated as there was no available data before the first check-up and the researchers did not evaluate the mortality of pancreatic cancer, since the National Health Insurance Service (NHIS) database did not provide exact information on whether a patient’s death was associated with pre-diagnosed cancer. “[W]e could not evaluate the correlation between the HbA1c levels of diabetic populations and pancreatic cancer incidence since the NHIS database did not collect the HbA1c levels; therefore, further study should be warranted whether the diabetic patients who are more intensively treated have a lower incidence of pancreatic cancer using a comparison of glucose levels and HbA1C levels,” the authors write.

“Our research implies that early detection of hyperglycemia in health checkups and lifestyle modification to improve glucose profile might offer a critical opportunity for lowering the risk of pancreatic cancer.”

Based on their findings, the authors conclude that the cumulative incidence rate of pancreatic cancer significantly increased with elevating fasting glucose level in both diabetic and prediabetic populations, including those with a normal range of fasting blood glucose levels. “Our research implies that early detection of hyperglycemia in health checkups and lifestyle modification to improve glucose profile might offer a critical opportunity for lowering the risk of pancreatic cancer,” Park says.

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