New-Onset Diabetes, Longitudinal Trends in Metabolic Markers, and Risk of Pancreatic Cancer in a Heterogeneous Population
New-Onset Diabetes, Longitudinal Trends in Metabolic Markers, and Risk of Pancreatic Cancer in a Heterogeneous Population
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DOI：
10.1016/j.cgh.2019.11.043
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发表时间：
2020-07-01
影响因子：
12.6
通讯作者：
Setiawan, Veronica Wendy
中科院分区：
文献类型：
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作者：
Huang, Brian Z.;Pandol, Stephen J.;Setiawan, Veronica Wendy
背景与目的：针对以白人为主的人群的观察性研究发现，新发糖尿病与胰腺癌风险增加相关。我们试图确定这种关系是否适用于其他种族或民族，并确定与胰腺癌风险增加相关的代谢特征。 方法：我们对 2006 年至 2016 年南加州 Kaiser Permanente 的亚裔、黑人、西班牙裔和白人患者进行了一项基于人群的队列研究（n = 1,499,627）。根据葡萄糖和糖化血红蛋白 (HbA1c) 测量结果来识别糖尿病患者。我们使用 Cox 回归来评估糖尿病状况和病程与胰腺癌之间的关系。对于最近诊断为糖尿病（1 年或更短）的患者，我们比较了患有和未患有胰腺癌的患者从糖尿病诊断时到诊断前 3 年的血糖、HbA1c 和体重的纵向变化。 结果：我们从近 750 万人年的随访中确定了 2,002 例胰腺癌病例。与非糖尿病患者相比，最近被诊断为糖尿病的个体患胰腺癌的风险几乎增加了 7 倍（相对风险，6.91；95% CI，5.76-8.30）。在最近诊断为糖尿病的患者中，患有胰腺癌的患者在诊断糖尿病前的一个月内，血糖水平（Delta 斜率：病例，37.47 mg/dL vs 非病例，27.68 mg/dL）和 HbA1c（Delta 斜率：病例，1.39% vs 非病例，0.86%）上升得更快，并且在前几年体重略有下降（斜率：病例 -0.18 kg/时间间隔）与非病例 0.33 千克/间隔相比）。这些代谢标志物的纵向变化对于特定种族和民族群体来说更为明显。结论：在一项针对大量不同种族人群的研究中，我们发现在过去一年中被诊断为糖尿病的不同种族和民族患者中，胰腺癌的风险增加。在多个种族中，体重减轻和血糖控制不良的迅速发展与胰腺癌风险增加有关。
BACKGROUND & AIMS: Observational studies of predominantly white populations have found new-onset diabetes to be associated with increased risk of pancreatic cancer. We sought to determine whether this relationship applies to other races or ethnicities and to identify metabolic profiles associated with increased risk of pancreatic cancer.METHODS: We conducted a population-based cohort study of Asian, black, Hispanic and white patients from Kaiser Permanente Southern California from 2006 through 2016 (n = 1,499,627). Patients with diabetes were identified based on glucose and hemoglobin A1c (HbA1c) measurements. We used Cox regression to assess the relationship between diabetes status and duration and pancreatic cancer. For patients with recent diagnoses of diabetes (1 year or less) we compared longitudinal changes in glucose, HbA1c, and weight, from time of diabetes diagnosis through 3 years prior to the diagnosis, in patients with vs without pancreatic cancer.RESULTS: We identified 2,002 incident cases of pancreatic cancer from nearly 7.5 million person-years of follow-up. Compared to patients without diabetes, individuals who received a recent diagnosis of diabetes had an almost 7-fold increase in risk of pancreatic cancer (relative risk, 6.91; 95% CI, 5.76-8.30). Among patients with a recent diagnosis of diabetes, those who developed pancreatic cancer had more rapid increases in levels of glucose (Delta slope: cases, 37.47 mg/dL vs non-cases, 27.68 mg/dL) and HbA1c (Delta slope: cases, 1.39% vs non-cases, 0.86%) in the month preceding the diagnosis of diabetes, and subtle weight loss in the prior years (slope: cases -0.18 kg/interval vs non-cases 0.33 kg/interval). These longitudinal changes in markers of metabolism were stronger for specific race and ethnic groups.CONCLUSIONS: In a study of a large ethnically diverse population, we found risk of pancreatic cancer to be increased among patients with a diagnosis of diabetes in the past year among different races and ethnicities. Weight loss and rapid development of poor glycemic control were associated with increased risk of pancreatic cancer in multiple races.