Type 2 diabetes is a known risk factor for the development of pancreatic adenocarcinoma. However, the mechanisms behind this epidemiological association remain unclear. Whether it is hyperglycemia or insulin resistance that increases the risk of pancreatic adenocarcinoma is a question that has yet to be settled. A new study by Kim et al published in The American Journal of Gastroenterology shows that the presence of insulin resistance independently increases pancreatic cancer mortality even in individuals without diabetes and hyperglycemia. The study's findings and implications to our understanding of pancreatic cancer risk are discussed.