Diabetes associated with pancreatic ductal adenocarcinoma is just diabetes

Results of a prospective observational study in surgical patients

Erica Dugnani, Alessandra Gandolfi, Gianpaolo Balzano, Marina Scavini, Valentina Pasquale, Francesca Aleotti, Daniela Liberati, Gaetano Di Terlizzi, Giovanna Petrella, Michele Reni, Claudio Doglioni, Emanuele Bosi, Massimo Falconi, Lorenzo Piemonti

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Identification of a specific diabetes signature associated to pancreatic ductal carcinoma (PDAC) could be a key to detect asymptomatic, early stage tumors. We aim to characterize the clinical signature and the pathogenetic factors of the different types of diabetes associated with PDAC, based on the time between diabetes and cancer diagnosis. Methods Prospective observational study on 364 PDAC patients admitted to a referral center for pancreatic disease. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up. Results The prevalence of diabetes in patients was 67%. Considering 174 patients (47.8%) already having diabetes when diagnosed with PDAC (long duration, short duration, concomitant), the clinical and biochemical profile was similar to that of patients with type 2 diabetes (T2D). Diabetes was associated with known risk factors (i.e., age, sex, family history for diabetes and increased BMI) and both beta-cell dysfunction and insulin resistance were present. Considering 70 patients (19.2%) with onset of diabetes after PDAC diagnosis (early and late onset), the strongest predictor was the loss of beta-cell mass following pancreatectomy in patients with risk factors for T2D. Conclusion Different types of diabetes according to the time between diabetes and PDAC diagnosis are clinical entities widely overlapping with T2D. Therefore, the success of a strategy considering diabetes onset as a marker of asymptomatic PDAC will largely depend on our ability to identify new diabetes-unrelated biomarkers of PDAC.

Original languageEnglish
Pages (from-to)844-852
Number of pages9
JournalPancreatology
Volume16
Issue number5
DOIs
Publication statusPublished - Sep 1 2016

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Pancreatic Ductal Carcinoma
Observational Studies
Adenocarcinoma
Prospective Studies
Type 2 Diabetes Mellitus
Pancreatic Diseases
Pancreatectomy
Aptitude
C-Peptide
Delayed Diagnosis
Glycosylated Hemoglobin A
Medical Records
Insulin Resistance
Blood Glucose
Anti-Idiotypic Antibodies
Fasting
Neoplasms
Outpatients
Referral and Consultation
Biomarkers

Keywords

  • Diabetes
  • Human
  • Pancreatic ductal carcinoma

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Diabetes associated with pancreatic ductal adenocarcinoma is just diabetes : Results of a prospective observational study in surgical patients. / Dugnani, Erica; Gandolfi, Alessandra; Balzano, Gianpaolo; Scavini, Marina; Pasquale, Valentina; Aleotti, Francesca; Liberati, Daniela; Di Terlizzi, Gaetano; Petrella, Giovanna; Reni, Michele; Doglioni, Claudio; Bosi, Emanuele; Falconi, Massimo; Piemonti, Lorenzo.

In: Pancreatology, Vol. 16, No. 5, 01.09.2016, p. 844-852.

Research output: Contribution to journalArticle

Dugnani, Erica ; Gandolfi, Alessandra ; Balzano, Gianpaolo ; Scavini, Marina ; Pasquale, Valentina ; Aleotti, Francesca ; Liberati, Daniela ; Di Terlizzi, Gaetano ; Petrella, Giovanna ; Reni, Michele ; Doglioni, Claudio ; Bosi, Emanuele ; Falconi, Massimo ; Piemonti, Lorenzo. / Diabetes associated with pancreatic ductal adenocarcinoma is just diabetes : Results of a prospective observational study in surgical patients. In: Pancreatology. 2016 ; Vol. 16, No. 5. pp. 844-852.
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AU - Scavini, Marina

AU - Pasquale, Valentina

AU - Aleotti, Francesca

AU - Liberati, Daniela

AU - Di Terlizzi, Gaetano

AU - Petrella, Giovanna

AU - Reni, Michele

AU - Doglioni, Claudio

AU - Bosi, Emanuele

AU - Falconi, Massimo

AU - Piemonti, Lorenzo

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N2 - Background Identification of a specific diabetes signature associated to pancreatic ductal carcinoma (PDAC) could be a key to detect asymptomatic, early stage tumors. We aim to characterize the clinical signature and the pathogenetic factors of the different types of diabetes associated with PDAC, based on the time between diabetes and cancer diagnosis. Methods Prospective observational study on 364 PDAC patients admitted to a referral center for pancreatic disease. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up. Results The prevalence of diabetes in patients was 67%. Considering 174 patients (47.8%) already having diabetes when diagnosed with PDAC (long duration, short duration, concomitant), the clinical and biochemical profile was similar to that of patients with type 2 diabetes (T2D). Diabetes was associated with known risk factors (i.e., age, sex, family history for diabetes and increased BMI) and both beta-cell dysfunction and insulin resistance were present. Considering 70 patients (19.2%) with onset of diabetes after PDAC diagnosis (early and late onset), the strongest predictor was the loss of beta-cell mass following pancreatectomy in patients with risk factors for T2D. Conclusion Different types of diabetes according to the time between diabetes and PDAC diagnosis are clinical entities widely overlapping with T2D. Therefore, the success of a strategy considering diabetes onset as a marker of asymptomatic PDAC will largely depend on our ability to identify new diabetes-unrelated biomarkers of PDAC.

AB - Background Identification of a specific diabetes signature associated to pancreatic ductal carcinoma (PDAC) could be a key to detect asymptomatic, early stage tumors. We aim to characterize the clinical signature and the pathogenetic factors of the different types of diabetes associated with PDAC, based on the time between diabetes and cancer diagnosis. Methods Prospective observational study on 364 PDAC patients admitted to a referral center for pancreatic disease. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up. Results The prevalence of diabetes in patients was 67%. Considering 174 patients (47.8%) already having diabetes when diagnosed with PDAC (long duration, short duration, concomitant), the clinical and biochemical profile was similar to that of patients with type 2 diabetes (T2D). Diabetes was associated with known risk factors (i.e., age, sex, family history for diabetes and increased BMI) and both beta-cell dysfunction and insulin resistance were present. Considering 70 patients (19.2%) with onset of diabetes after PDAC diagnosis (early and late onset), the strongest predictor was the loss of beta-cell mass following pancreatectomy in patients with risk factors for T2D. Conclusion Different types of diabetes according to the time between diabetes and PDAC diagnosis are clinical entities widely overlapping with T2D. Therefore, the success of a strategy considering diabetes onset as a marker of asymptomatic PDAC will largely depend on our ability to identify new diabetes-unrelated biomarkers of PDAC.

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