2966-LB: Serum Uric Acid and Pancreatic Cancer Risk in Patients with Type 2 Diabetes: Findings from the Tianjin Diabetes and Health Cohort

Introduction and Objective: Patients with type 2 diabetes (T2D) have an increased risk of pancreatic cancer (PC), but practical markers for identifying high-risk individuals are limited. We aimed to determine whether baseline and longitudinal serum uric acid (SUA) levels were associated with incident PC in T2D. Methods: We conducted a retrospective cohort study using the Tianjin Diabetes and Health Cohort. Patients aged at least 20 years with T2D and no prior PC were included. The primary exposure was time-weighted mean SUA, analyzed continuously, by quintiles, and by sex-specific clinical categories (normal range: 208-428 μmol/L in men and 155-357 μmol/L in women). Baseline SUA was a secondary exposure. The outcome was incident PC identified by ICD-10 code C25. Propensity score-adjusted Cox models estimated hazard ratios (HRs) and 95% CIs. Restricted cubic splines assessed dose-response relationships, and linear mixed-effects models compared longitudinal SUA trajectories. Results: Among 236,936 patients with T2D, 682 developed PC. Time-weighted mean SUA showed a significant nonlinear, L-shaped association with PC risk (overall P<0.001; nonlinearity P<0.001), with risk rising sharply below approximately 300 μmol/L and no further change in PC risk above this value. Compared with the lowest quintile, the highest quintile of SUA had lower risk (HR 0.23, 95% CI 0.18-0.30). Relative to the normal range, low SUA was associated with higher PC risk (HR 3.26, 95% CI 2.67-3.98), whereas high SUA was associated with lower risk (HR 0.53, 95% CI 0.41-0.70). Baseline SUA showed similar but weaker associations. Longitudinally, patients who developed PC had lower baseline SUA and a declining trajectory before PC diagnosis, whereas SUA increased over time in those without PC. Conclusion: In patients with T2D, lower SUA was associated with higher PC risk, and this association was stronger for longitudinal than baseline SUA. Distinct prediagnostic SUA trajectories may help identify patients with T2D at elevated risk of PC.