Global 
Deutschland Pancreas
Gastroenterology. 2026;170(1):106-117
Risk of pancreatic cancer in glycemically defined new-onset diabetes: A prospective cohort study
Background and aims: The increased 3-year incidence of pancreatic cancer after new-onset diabetes observed in retrospective studies needs prospective validation. It is unknown whether incidence varies by race and ethnicity.
Methods: In a prospective, observational study using active real-time surveillance of electronic health records, the authors identified 18,838 adults 50 years or older with glycemically defined new-onset diabetes (GNOD). In this interim analysis, they report 3-year Kaplan-Meier estimates of the proportion diagnosed with pancreatic cancer after GNOD (absolute incidence [95% CI]) and associated standardized incidence ratio (SIR) by race and ethnicity, overall 3-year incidence of pancreatic cancer adjusting for racial distribution of incident diabetes in the United States, and interval between GNOD and pancreatic cancer diagnosis.
Results: During median follow-up of 2.3 years, 82 pancreatic cancers were diagnosed (60% in men; mean [SD] age, 71 [8] years). The 3-year estimates for the proportion diagnosed with pancreatic cancer and associated SIR by race and ethnicity were as follows: non-Hispanic White patients (n = 6518): 0.84% (95% CI: 0.60−1.07) and 6.4 (95% CI: 4.8−8.4); Hispanic patients (n = 5984): 0.40% (95% CI: 0.20−0.60) and 4.2 (95% CI: 2.6−6.3); African American patients (n = 2192): 0.37% (95% CI: 0.07−0.67) and 2.4 (95% CI: 1.0−5.0), and Asian/Pacific Islander patients (n = 3360): 0.22% (95% CI: 0.06−0.39) and 3.0 (95% CI: 1.4−6.0). Overall, race-adjusted 3-year pancreatic cancer incidence was 0.62%. On average, GNOD occurred 8 months before clinical diagnosis (0−4 months in 30.5%, 4−12 months in 31.3%, 12−24 months in 19.5%, and 24−36 months in 18.7%).
Conclusions: GNOD, identifiable in real time using active surveillance of electronic health records, is associated with a high 3-year incidence of pancreatic cancer with marked racial and ethnic differences. Longer-term risk needs further study.