Originally published by our sister publication Gastroenterology & Endoscopy News
By Marcus A. Banks
WASHINGTON—New-onset diabetes in adults older than 50 years of age could be a manifestation of pancreatic cancer, with increasing glucose levels starting months before a cancer diagnosis, according to new research.
When coupled with weight loss, the risk for underlying pancreatic cancer increases to a level similar to that found when a person has a family history of pancreatic cancer, said Suresh Chari, MD, a gastroenterologist and professor of medicine at the The University of Texas MD Anderson Cancer Center, in Houston, speaking at DDW 2024.
“We need to act quickly” to identify new cases of diabetes, Dr. Chari told Gastroenterology & Endoscopy News, as time from elevation in hemoglobin A1c levels above diabetes thresholds to diagnosis of cancer is around eight months (Diabet Med 2018;35[12]:1655-1662).
At DDW, Dr. Chari presented an interim analysis of the REGARD study, an ongoing observational study that evaluates people at least 50 years of age with new-onset diabetes to track the development of pancreatic cancer. The researchers used an algorithm to scan EHRs for evidence of new-onset diabetes—defined as an A1c level of at least 6.5%, with no evidence of diabetes in the prior 18 months—and then followed the patients.
Among the 18,944 participants in the REGARD cohort, all with new-onset diabetes, there were 82 cases of pancreatic cancer from September 2018 to May 2022 (median follow-up, 2.3 years). The highest number of cases occurred in those who were non-Hispanic white (28). This was eight times higher than the expected number based on the general incidence of pancreatic cancer in the United States. Pancreatic cancer incidence was lower in people of other races but still higher than for the general population.
They found that diagnosis of pancreatic cancer occurred more than four months after glucose levels had reached diabetic levels 65% of the time.
These findings coincide with the ENDPAC (Enriching New-Onset Diabetes for Pancreatic Cancer) model for elevated pancreatic cancer risk in new-onset diabetes, which showed that people who are at least 50 before they develop new-onset diabetes and are losing weight are at greater risk (Gastroenterology 2018;155[3]:730-739).
Dr. Chari, who was the senior investigator on the new model study, said that “studies need to be done to show that [identifying people who] meet blood sugar criteria for diabetes, particularly people who are also losing weight, will lead to earlier detection of pancreatic cancer.”
An Inflection Point in Pancreatic Cancer Screening
“There is an increased interest in ambient biomarkers of pancreatic cancer risk, which is usually data collected for some other purpose,” said Michael B. Wallace, MD, MPH, the Fred C. Andersen Professor of Medicine at Mayo Clinic in Florida, Jacksonville.
Dr. Wallace, who was not part of the REGARD study, noted that glucose levels are one example of a biomarker obtained for another purpose—perhaps an annual physical—that also can be used to indicate elevated cancer risk. Other recently identified markers, such as an unplanned drop in cholesterol or signs seen on a CT scan for suspected appendicitis, also could show a decline in weight or muscle mass. Many of these changes happen up to three years before a clinically overt cancer, he noted.
“These signs and symptoms should be red flags for pancreatic cancer screening. But we shouldn’t depend on doctors to connect these very subtle dots. We need, and are currently writing, algorithms that connect the dots for them,” Dr. Wallace said.
Current pancreatic cancer screening guidelines, from the International Cancer of the Pancreas Screening Consortium, call for an annual MRI or endoscopic ultrasound for people with certain genetic mutations or a family history of pancreatic cancer. Dr. Wallace said he anticipated that elevated glucose combined with a drop in weight in people older than 50 will likely be added as indicators of a high-risk category.
He said he also is studying how artificial intelligence tools can spot signs of pancreatic cancer that radiologists miss on radiological scans and noted that DNA tests of pancreatic enzymes also show promise to identify early cancer markers.
“We are now at a threshold point for pancreatic cancer screening,” Dr. Wallace said. “If we can detect pancreatic cancer at stage I or in the precancerous stage, we can usually cure it.”
The sources reported no relevant financial disclosures.