New-Onset Diabetes Associated With IPMN Progression

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New-onset diabetes, but not baseline diabetes, is associated with an increased risk of progression of intraductal papillary mucinous neoplasms.
New-onset diabetes, but not baseline diabetes, is associated with an increased risk of progression of intraductal papillary mucinous neoplasms.

New-onset diabetes is associated with an increased risk of developing high-risk stigmata or cancer among patients with intraductal papillary mucinous neoplasms (IPMN), according to a retrospective study presented at the AACR Pancreatic Cancer: Advances in Science and Clinical Care conference in Boston, Massachusetts.1

Most pancreatic cystic lesions do not progress to pancreatic cancer; however, the required surveillance can pose a substantial burden. Prior studies have suggested that metabolic parameters may be associated with pancreatic cancer. The aim of this study was to determine if baseline or new-onset diabetes was associated with progression of low-risk IPMN to cancer.

The retrospective review included prospective data collected from 470 patients with low-risk IPMN between 2003 and 2016. Patients demonstrated no worrisome features or high-risk stigmata at baseline. Prospective data points included random and fasting glucose, history of diabetes, HbA1C levels, and body mass index (BMI), which were determined throughout a minimum of 12 months of follow-up.

At baseline, 28% of patients had diabetes and, of the patients with BMI data, 25% were obese, which was defined as at least  30 kg/m2. An additional 7% of patients developed new-onset diabetes during follow-up, defined as a random plasma glucose of at least 200 mg/dL or an HbA1c of at least  6.5% at 3 months or longer following the patient's initial diagnosis.

Progression of IPMN to worrisome features occurred in 13% of patients, and 5% developed high-risk stigmata or cancer. There was no association between baseline diabetes in the entire cohort or the nonobese cohort and IPMN progression.

New-onset diabetes significantly increased the risk of developing high-risk stigmata or cancer in the entire (relative risk [RR], 2.83; 95% CI, 1.08-7.42; P = .049) and nonobese (RR, 5.54; 95% CI, 2.02-15.19; P = .008) cohorts. New-onset diabetes, however, was not associated with the development of worrisome features.

The authors concluded that “these data further support the inclusion of new-onset diabetes mellitus as a risk factor for IPMN progression.”

Reference

  1. Brooks C, Hu G, Gausman V, et al. Association between progression of low-risk IPMNs and diabetes mellitus. Presented at: AACR Pancreatic Cancer: Advances in Science and Clinical Care; Boston, Massachusetts: September 21-24, 2018. Abstract A107.

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