Characterization of the deterioration of diabetes control in patients with a subsequent diagnosis of pancreatic cancer: A descriptive study

Background: Deterioration of diabetes control can be the first harbinger of pancreatic cancer. However, little is known about how to distinguish patients with pancreatic cancer-related diabetes deterioration from those with type 2 diabetes progression. We aimed to characterize the glycated hemoglobin (HbA(1c)) and body weight profile of pancreatic cancer patients with deteriorating diabetes before the cancer diagnosis. Methods: Using data from the UK-based Clinical Practice Research Datalink (CPRD) GOLD, we established a study population including pancreatic cancer patients with diabetes deterioration in the >0.5-3 years before the cancer diagnosis and non-cancer patients with deterioration of type 2 diabetes (comparison group). Patients were considered to have diabetes deterioration if their glucose-lowering treatment was intensified. We characterized the longitudinal trajectories of HbA(1c) and body weight in pancreatic cancer patients compared with non-cancer patients before and after treatment intensification. Results: The mean absolute increase in HbA(1c) from the pre-deterioration period, i.e. the time >1-2 years before treatment intensification, to the time of treatment intensification, was 1.5% +/- 1.6% in pancreatic cancer patients vs. 0.9% +/- 1.4% in non-cancer patients. After treatment intensification, mean HbA(1c) remained elevated in pancreatic cancer patients, while it returned to the pre-deterioration level in non-cancer patients. Body weight decreased by 1.9% +/- 6.4% in cancer patients and increased by 0.3% +/- 5.2% in non-cancer patients between the pre-deterioration period and treatment intensification, on average. Conclusions: Pancreatic cancer-related diabetes deterioration may frequently be characterized by pronounced increases in HbA(1c), persistent elevation of HbA(1c) after treatment intensification, and concomitant weight loss. (C) 2022 The Authors. Published by Elsevier B.V. on behalf of IAP and EPC.

Automated summary

Pancreatic cancer-related diabetes deterioration is characterized by pronounced increases in HbA(1c), persistent elevation of HbA(1c) after treatment intensification, and concomitant weight loss.