Oral 1 Using Large Sample Real World Data to Study the Progression of Low Risk Pancreatic Cysts: New Onset Diabetes as a Potential Biomarker of Malignant Transformation

Author Insight from Adam Schweber, MD, New York-Presbyterian/Columbia University Medical Center

What’s new here and important for clinicians?

It is estimated that approximately 2% of the population has a pancreatic cyst, some of which are precursor lesions for pancreatic cancer. The challenge facing clinicians has been to identify predictive biomarkers for the malignant transformation of low-risk pancreatic cysts to pancreatic cancer. Most prior studies of biomarkers for this malignant transformation have been limited by sample size, with most surveillance cohorts consisting of hundreds of patients. Using real world data, we were able to study tens of thousands of patients with a pancreatic cyst. We found that patients with a pancreatic cyst who were newly diagnosed with diabetes mellitus (so-called “new-onset diabetes) developed pancreatic cancer at over three times the rate of patients not diagnosed with diabetes. Furthermore, we found that the cumulative risk of developing pancreatic cancer steadily increases linearly with time. Given the low cost and ease of diabetes screening and the high mortality associated with pancreatic cancer, these results strongly argue for ongoing diabetes screening (fasting glucose and HbA1C) in the surveillance regimens used by clinicians to follow patients with low-risk pancreatic cysts.

What do patients need to know?

For those patients with a pancreatic cyst, a new diagnosis of diabetes may present a significantly greater risk for the development of pancreatic cancer. Patients with a pancreatic cyst should discuss with their physicians the potential benefits of ongoing diabetes screening as part of the surveillance of their cyst.