Pancreas

Clin Gastroenterol Hepatol. 2022;20(5):1105–11.e2

Brewer MJ, Doucette JT, Bar-Mashiah A, Glickman JW, Kessel E, Aronson A, Lucas AL

Glycemic changes and weight loss precede pancreatic ductal adenocarcinoma by up to 3 years in a diverse population


Background and aims: Elevations in fasting blood glucose are observed prior to the development of pancreatic ductal adenocarcinoma (PDAC). The aim of the present study was to describe glycemic and weight changes that occur prior to PDAC diagnosis in a diverse population.
Methods: The authors conducted a case-control study comparing patients with PDAC with matched controls between January 2011 and November 2019 at a tertiary care institution. Normally distributed variables were compared using t tests, and the Wilcoxon rank sum test was used for non-normally distributed variables; logistic regression was used to estimate odds of PDAC based on changes over time in hemoglobin A1c (HbA1c) and body-mass index (BMI), controlling for appropriate confounders.
Results: A total of 4626 patients met inclusion criteria: 1542 cases and 3084 controls; the median age was 69.3 years, and 2487 (53.8%) were male; 751 cases (48.7%) were non-Hispanic white. In the 3 years prior to diagnosis, HbA1c was higher in patients with PDAC compared with controls (p ≤ 0.02 for all); a similar trend was seen for glucose values. BMI was greater for patients with PDAC for all study periods, except 0–6 months prior to cancer diagnosis when BMI was lower (p < 0.01 for all). The change in BMI (ΔBMI) of cases at 1 year and 6 months before diagnosis was -0.59 and -1.21 when compared with -0.08 and 0.03 for controls (p < 0.01 for both). Multivariable logistic regression demonstrated that HbA1c slope (adjusted odds ratio [aOR] = 1.33; 95% confidence interval [CI]: 1.01–1.76) and BMI slope (aOR = 0.75; 95% CI: 0.65–0.87) were predictors of PDAC.

Conclusion: Glycemic elevations and weight loss predate pancreatic ductal adenocarcinoma (PDAC) diagnosis. These metabolic changes may suggest an underlying PDAC.

A.L. Lucas, M.D., Associate Professor of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,
E-Mail: aimee.lucas@mssm.edu

DOI: DOI: 10.1016/j.cgh.2021.07.046

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