BMI and HbA1c as metabolic markers for pancreatic cancer

Last edited 11/2022 and last reviewed 03/2023

BMI and HbA1c as metabolic markers for pancreatic cancer

New-onset diabetes may indicate subclinical pancreatic cancer, and patients with new-onset diabetes may constitute a population in whom pancreatic cancer can be detected early (1)

• been reported that the prevalence of diabetes and impaired glucose tolerance in pancreatic cancer cases is as high as 80% (1,2)
  • in the majority of cases, diabetes associated with pancreatic cancer is diagnosed fewer than 2 years prior to the cancer diagnosis or during the cancer course
  • among patients with early-stage pancreatic cancer, diabetes has developed more often in patients with carcinoma of the head of the pancreas than in those with carcinoma of the body and/or tail of the organ
    • the reasons why diabetes develops in patients with pancreatic cancer remains unclear
    • nearly half the patients with early stage, resectable tumors have diabetes (2)

A study by Lemanska et al showed that statistically significant changes in weight and glycaemic control started three years before pancreatic cancer diagnosis but varied according to the diabetes status:

• odds ratios were adjusted for demographic and lifestyle factors (aOR)
• in the year before diagnosis, a 1 kg/m2 decrease in BMI between cases and controls was associated with aOR for pancreatic cancer of 1.05 (95% CI 1.05 to 1.06), and a 1 mmol/mol increase in HbA1c was associated with aOR of 1.06 (1.06 to 1.07)
  • ORs remained statistically significant (p < 0.001) for 2 years before pancreatic cancer diagnosis for BMI and 3 years for HbA1c
  • subgroup analysis revealed that the decrease in BMI was associated with a higher pancreatic cancer risk for people with diabetes than for people without (aORs 1.08, 1.06 to 1.09 versus 1.04, 1.03 to 1.05), but the increase in HbA1c was associated with a higher risk for people without diabetes than for people with diabetes (aORs 1.09, 1.07 to 1.11 versus 1.04, 1.03 to 1.04)

Reference:

• Li D. Diabetes and pancreatic cancer. Mol Carcinog. 2012;51(1):64-74. doi:10.1002/mc.20771
• Pannala R, Basu A, Petersen GM, Chari ST. New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol. 2009;10(1):88-95.doi:10.1016/S1470-2045(08)70337-1
• Lemanska A, Price CA, Jeffreys N, Byford R, Dambha-Miller H, Fan X, Hinton W, Otter S, Rice R, Stunt A, Whyte MB, Faithfull S, de Lusignan S. BMI and HbA1c are metabolic markers for pancreatic cancer: Matched case-control study using a UK primary care database. PLoS One. 2022 Oct 5;17(10):e0275369.