The Incremental Risk of Pancreatic Cancer According to Fasting Glucose Levels: Nationwide Population-Based Cohort Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 104; no. 10; pp. 4594 - 4599
• Main Authors: Koo, Dong-Hoe, Han, Kyung-Do, Park, Cheol-Young
• Format: Journal Article
• Language: English
• Published: Washington, DC Endocrine Society 01.10.2019; Copyright Oxford University Press; Oxford University Press
• Subjects: Blood sugar; Body mass index; Cancer; Cohort analysis; Diabetes; Diabetes mellitus; Fasting; Glucose; Health risk assessment; Hypoglycemic agents; National health insurance; Oncology, Experimental; Pancreatic cancer; Population studies; Population-based studies; Prediabetic state; Risk factors; South Korea
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2019-00033

Abstract Context It has been unclear whether the risk of pancreatic cancer is different according to glucose levels. Objective To determine the association between fasting glucose levels and pancreatic cancer risk using prospectively collected nationwide population-based cohort data in Korea. Design The National Health Insurance Service database of claims and preventive health check-up data recorded was used between 2009 and 2015. Setting and Participants A total of 25.4 million patients who had participated in a preventive health check-up between 2009 and 2013 were evaluated for pancreatic cancer incidence rates according to fasting glucose level. Main Outcomes Measures The cumulative incidence rate for pancreatic cancer was calculated after grouping according to fasting glucose levels as follows: (i) low normal (<90 mg/dL), (ii) high normal (90 to 99 mg/dL), (iii) prediabetes level 1 (100 to 109 mg/dL), (iv) prediabetes level 2 (110 to 125 mg/dL), (v) diabetes (≥126 mg/dL), and (vi) diabetes on anti-diabetic medications. Results The 5-year cumulative incidence rates (per 100,000) were as follows: (i) low normal = 32; (ii) high normal = 41; (iii) prediabetes level 1 = 50; (iv) prediabetes level 2 = 64; (v) diabetes = 75; and (vi) on anti-diabetic medications = 121. The risk of pancreatic cancer increased continuously with elevating fasting glucose levels (P < 0.0001). 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 (P < 0.0001). Conclusions The cumulative incidence rate of pancreatic cancer significantly increased as the fasting glucose level elevated, even in populations with a normal glucose level range. As the fasting glucose level elevated, the incidence of pancreatic cancer significantly increased, not only in diabetic populations but also in those with prediabetes or normal glucose levels.