Epidemiology of pancreatic cancer in patients with diabetes mellitus

Abstract Introduction: Diabetes mellitus (DM) is closely associated with pancreatic cancer. We aimed to describe the prevalence of pancreatic cancer among patients with DM in Singapore, compare their profiles and identify variables associated with pancreatic cancer in this population. Methods: We conducted a case–control study using data from a multi-institutional diabetes registry in Singapore from 2013 to 2019. Subjects with pancreatic cancer were identified and matched with cancer-free controls. Data such as demographics, clinical parameters, laboratory results, medications and comorbidities were analysed. Logistic regression was used to identify variables associated with pancreatic cancer. Results: A total of 1079 subjects with pancreatic cancer were identified. Pancreatic cancer was the seventh most common cancer, with a prevalence of 0.45%, and accounted for 7.5% of all cancers in patients with DM. Independent variables associated with higher odds of pancreatic cancer were insulin use (odds ratio OR 7.60; 95% confidence interval CI 5.63–10.40; P < 0.001), absence of hyperlipidaemia (OR 2.08, 95% CI 1.32–3.33; P = 0.002), absence of cardiovascular disease (OR 1.43; 95% CI 1.09–1.89; P = 0.012), higher haemoglobin A1c (OR 1.15; 95% CI 1.06–1.23; P < 0.001), shorter DM duration (OR 0.98; 95% CI 0.96–0.99; P = 0.002) and lower body mass index (OR 0.92; 95% CI 0.89–0.94; P < 0.001). Conclusion: Patients with DM and pancreatic cancer had poorer DM control, lower body mass index, a lower prevalence of hypertension, hyperlipidaemia and micro- and macrovascular complications, and higher insulin use compared with matched controls.