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Pattern of increasing HbA(1c) levels in patients with diabetes mellitus before clinical detection of pancreatic cancer - a population-based nationwide case-control study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17177 Stockholm, Sweden..
Registerctr VGR, Natl Diabet Register, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17177 Stockholm, Sweden..
2015 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 54, no 7, 986-992 p.Article in journal (Refereed) Published
Abstract [en]

Background. Diabetes mellitus is a risk factor for pancreatic cancer. Impaired insulin resistance might precede the clinical detection of this cancer by several years. Methods. This was a nested case-control population-based study assessing the pattern of glycated hemoglobin (HbA(1c)) change before clinical detection of pancreatic cancer in a population of individuals with diabetes mellitus. All patients registered in the Swedish National Diabetes Register with a prescription of an anti-diabetic drug between 2005 and 2011 were identified. For each case of pancreatic cancer, 10 controls were randomly selected, matched for age, sex, and factors related to diabetes mellitus. Multivariable conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between HbA(1c) and pancreatic cancer. Results. In total, 391 cases and 3910 matched controls were identified. The risk of pancreatic cancer was increased more than two-fold in individuals with the highest HbA(1c) quartile compared with the lowest (OR 1.96, 95% CI 1.40-2.75). The risk of pancreatic cancer remained elevated when comparing the highest HbA(1c) quartile measured within five years from the clinical detection of pancreatic cancer to the lowest HbA(1c) quartile (p-value for trend < 0.05). No association was found between HbA(1c) and pancreatic cancer if HbA(1c) was measured > 5 years before the clinical detection of pancreatic cancer. Conclusions. The pattern of increasing HbA(1c) in patients with diabetes mellitus preceded the clinical detection of pancreatic cancer by up to five years. These findings indicate that there is a lead time of several years during which the development of pancreatic cancer might be detectable through screening in patients with diabetes mellitus.

Place, publisher, year, edition, pages
2015. Vol. 54, no 7, 986-992 p.
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-264679DOI: 10.3109/0284186X.2015.1006402ISI: 000361284900004PubMedID: 25734801OAI: oai:DiVA.org:uu-264679DiVA: diva2:861291
Funder
Swedish Cancer Society
Available from: 2015-10-16 Created: 2015-10-15 Last updated: 2017-12-01Bibliographically approved

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