Longer duration of diabetes is associated with a modestly increased risk of developing pancreatic cystic neoplasms, based on the results of a Korean nationwide population-based cohort study published in JAMA Network Open. Cho et al noted that the association was more pronounced among younger patients, males, and current smokers.
“Although these findings do not establish causality, they suggest that metabolic dysregulation may be a factor in pancreatic cyst development,” the investigators commented.
Study Details
The study included patients aged at least 20 years who underwent health examinations in 2009 at medical institutions designated by the Korean National Health Insurance Service. They were followed through December 31, 2020.
All patients were categorized as having normoglycemia, impaired fasting glucose, shorter diabetes duration (< 5 years), or longer diabetes duration (≥ 5 years). Demographic characteristics, lifestyle factors, and comorbidities at the time of health examination were assessed. Adjusted hazard ratios (aHRs) for pancreatic cyst development across diabetes status groups were calculated using Cox proportional hazards regression models, with adjustment for potential confounding variables.
Among 3,856,676 patients included in the analysis (mean age = 47.1 years; 54.5% male), 330,138 (8.6%) had diabetes. The median duration of follow-up was 10.3 years.
Key Findings
During the follow-up period, a total of 31,877 patients (0.8%) developed pancreatic cysts. Compared with patients with normoglycemia, the aHR for pancreatic cyst development was 1.06 (95% confidence interval [CI] = 1.03–1.08) among those with impaired fasting glucose, 1.23 (95% CI = 1.18–1.28) among those with shorter diabetes duration, and 1.37 (95% CI = 1.31–1.44) among those with longer diabetes duration.
Based on subgroup analyses, the association between diabetes and pancreatic cyst occurrence was greater among patients younger than age 60 (aHR = 1.34, 95% CI = 1.27–1.40) compared with their older counterparts (aHR = 1.21, 95% CI = 1.16–1.27). Similarly, males with diabetes had a higher adjusted risk (aHR = 1.32, 95% CI = 1.26–1.38) compared with females (aHR = 1.20, 95% CI, 1.15–1.26). Among current smokers with diabetes, the aHR was 1.40 (95% CI = 1.30–1.51), compared with 1.22 (95% CI = 1.18–1.28) among never-smokers and 1.25 (95% CI = 1.16–1.35) among former smokers.
“These findings suggest that diabetes may be a factor in the development of pancreatic cystic neoplasms and highlight the potential need for targeted surveillance in individuals with diabetes,” the investigators concluded. They continued, “Despite the inherent limitations of the claims-based design, this study provides valuable epidemiologic evidence … in a large nationwide population. Health-care professionals should consider [our findings], especially when evaluating pancreatic findings in patients with diabetes and additional risk factors.”
Looking ahead, they added, “Further prospective studies incorporating imaging and molecular data are warranted to clarify the clinical significance and biologic mechanisms underlying this association.”
Sang Hyub Lee, MD, PhD, of Seoul National University College of Medicine, and Kyung-Do Han, PhD, of Soongsil University, Seoul, are the corresponding authors of the article in JAMA Network Open.
DISCLOSURE: The study authors reported no conflicts of interest.
