From the Guidelines
Yes, pancreatic cancer can cause hyperglycemia, as evidenced by numerous studies showing an association between new-onset non-insulin–dependent diabetes and the development of pancreatic cancer. This occurs because the pancreas has two critical functions: producing digestive enzymes and producing hormones like insulin that regulate blood sugar. When cancer damages the insulin-producing cells in the pancreas, the body cannot properly regulate glucose levels, leading to hyperglycemia 1.
Key Points to Consider
- A systematic review and dose-response meta-analysis including 9 prospective studies (n=2,408) showed that every 0.56 mmol/L increase in fasting blood glucose is associated with a 14% increase in pancreatic cancer incidence, highlighting the link between hyperglycemia and pancreatic cancer risk 1.
- The relationship between pancreatic cancer and hyperglycemia works in both directions - long-standing diabetes is also a risk factor for developing pancreatic cancer, although the strength of this association decreases with duration of diabetes 1.
- New-onset diabetes or worsening of existing diabetes can sometimes be an early warning sign of pancreatic cancer, especially in those who are elderly, have a lower BMI, experience weight loss, or do not have a family history of diabetes 1.
- Patients with unexplained hyperglycemia, especially when accompanied by other symptoms like unexplained weight loss, abdominal pain, or jaundice, should be evaluated for pancreatic cancer.
Management Considerations
- Management typically involves treating both the cancer and the hyperglycemia, often requiring insulin therapy as the pancreatic function deteriorates.
- The use of diabetic medications such as metformin may be associated with a reduced risk for pancreatic cancer, and metformin use has been reported to result in higher pancreatic cancer survival in patients with diabetes 1.
From the Research
Pancreatic Cancer and Hyperglycemia
- Pancreatic cancer can cause hyperglycemia, as it can lead to insulin resistance and hyperinsulinemia 2, 3, 4.
- Hyperinsulinemia has been identified as a risk factor for pancreatic cancer, and the rapid rise of hyperinsulinemia associated with obesity and type 2 diabetes may foreshadow a rise in cancer incidence 5.
- Studies have shown that diabetic patients with pancreatic cancer have a higher risk of hyperglycemia, and that hyperglycemia can be a marker for pancreatic cancer risk 4.
Mechanisms of Hyperglycemia in Pancreatic Cancer
- Insulin resistance and hyperinsulinemia can contribute to the development of pancreatic cancer, as they can lead to the activation of various cellular pathways that promote cell growth and survival 2, 5.
- The proinsulin to insulin ratio has been shown to be a marker of pancreatic β-cell dysfunction, but it is not associated with pancreatic cancer risk 4.
- Circulating markers of peripheral insulin resistance, such as insulin and proinsulin, have been independently associated with pancreatic cancer risk 4.
Treatment and Prevention of Hyperglycemia in Pancreatic Cancer
- Metformin, a commonly used antidiabetic medication, has been shown to have a potential role in the prevention and treatment of pancreatic cancer, as it can lower insulin resistance and hyperinsulinemia 2, 3, 6.
- Other antidiabetic medications, such as insulin and insulin secretagogues, may increase the risk of pancreatic cancer, while metformin may reduce the risk 6.
- Weight loss in the setting of new-onset diabetes can help identify patients at an increased risk for harboring pancreatic-cancer related disturbances in glucose metabolism 3.