Diabetes Mellitus in Pancreatic Cancer: A Distinct Approach to Older Subjects with New-Onset Diabetes Mellitus
| Authors | |
|---|---|
| Year of publication | 2023 |
| Type | Article in Periodical |
| Magazine / Source | Cancers |
| MU Faculty or unit | |
| Citation | |
| Web | https://www.mdpi.com/2072-6694/15/14/3669 |
| Doi | http://dx.doi.org/10.3390/cancers15143669 |
| Keywords | age over 60 years; diagnostic algorithm; new-onset diabetes mellitus; pancreatic ductal adenocarcinoma |
| Description | Simple Summary Pancreatic ductal adenocarcinoma remains one of the most serious malignancies and a leading cause of cancer-related deaths worldwide. There are no effective screening methods available so far, even for high-risk individuals. At the time of diagnosis, impaired glucose metabolism is present in about 3/4 of all patients. Several types of diabetes mellitus can be found in pancreatic cancer; however, type 2, pancreatic-cancer-associated type 3c, and diabetes mellitus associated with non-malignant diseases of the exocrine pancreas (with a reduction or loss of islet-cell mass) are the most frequent ones. This paper proposed a distinct approach to older subjects with new-onset diabetes mellitus with possible pancreatic cancer. It could improve the current unsatisfactory situation in diagnostics and subsequent poor outcomes of treatment of pancreatic ductal adenocarcinoma. Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis, with near-identical incidence and mortality. According to the World Health Organization Globocan Database, the estimated number of new cases worldwide will rise by 70% between 2020 and 2040. There are no effective screening methods available so far, even for high-risk individuals. The prognosis of PDAC, even at its early stages, is still mostly unsatisfactory. Impaired glucose metabolism is present in about 3/4 of PDAC cases. Methods: Available literature on pancreatic cancer and diabetes mellitus was reviewed using a PubMed database. Data from a national oncology registry (on PDAC) and information from a registry of healthcare providers (on diabetes mellitus and a number of abdominal ultrasound investigations) were obtained. Results: New-onset diabetes mellitus in subjects older than 60 years should be an incentive for a prompt and detailed investigation to exclude PDAC. Type 2 diabetes mellitus, diabetes mellitus associated with chronic non-malignant diseases of the exocrine pancreas, and PDAC-associated type 3c diabetes mellitus are the most frequent types. Proper differentiation of particular types of new-onset diabetes mellitus is a starting point for a population-based program. An algorithm for subsequent steps of the workup was proposed. Conclusions: The structured, well-differentiated, and elaborately designed approach to the elderly with a new onset of diabetes mellitus could improve the current situation in diagnostics and subsequent poor outcomes of therapy of PDAC. |