Characterization of the deterioration of diabetes control in patients with a subsequent diagnosis of pancreatic cancer: A descriptive study

Journal: Pancreatology

Authors: Alexandra M Mueller, Christoph R Meier, Susan S Jick, Cornelia Schneider

NLM Citation: Mueller AM, Meier CR, Jick SS, Schneider C. Characterization of the deterioration of diabetes control in patients with a subsequent diagnosis of pancreatic cancer: A descriptive study. Pancreatology. 2022 Apr;22(3):387-395. doi: 10.1016/j.pan.2022.03.012. Epub 2022 Mar 14. PMID: 35314354.

Abstract

Background: Deterioration of diabetes control can be the first harbinger of pancreatic cancer. However, little is known about how to distinguish patients with pancreatic cancer-related diabetes deterioration from those with type 2 diabetes progression. We aimed to characterize the glycated hemoglobin (HbA_1c) and body weight profile of pancreatic cancer patients with deteriorating diabetes before the cancer diagnosis.

Methods: Using data from the UK-based Clinical Practice Research Datalink (CPRD) GOLD, we established a study population including pancreatic cancer patients with diabetes deterioration in the >0.5-3 years before the cancer diagnosis and non-cancer patients with deterioration of type 2 diabetes (comparison group). Patients were considered to have diabetes deterioration if their glucose-lowering treatment was intensified. We characterized the longitudinal trajectories of HbA_1c and body weight in pancreatic cancer patients compared with non-cancer patients before and after treatment intensification.

Results: The mean absolute increase in HbA_1c from the pre-deterioration period, i.e. the time >1-2 years before treatment intensification, to the time of treatment intensification, was 1.5% ± 1.6% in pancreatic cancer patients vs. 0.9% ± 1.4% in non-cancer patients. After treatment intensification, mean HbA_1c remained elevated in pancreatic cancer patients, while it returned to the pre-deterioration level in non-cancer patients. Body weight decreased by 1.9% ± 6.4% in cancer patients and increased by 0.3% ± 5.2% in non-cancer patients between the pre-deterioration period and treatment intensification, on average.

Conclusions: Pancreatic cancer-related diabetes deterioration may frequently be characterized by pronounced increases in HbA_1c, persistent elevation of HbA_1c after treatment intensification, and concomitant weight loss.

Keywords: CPRD; HbA(1c); Pancreatic cancer; Type 2 diabetes; Weight.