Predicting the risk of pancreatic cancer in women with new-onset diabetes mellitus

Sitwat Ali; Michael Coory; Peter Donovan; Renhua Na; Nirmala Pandeya; Sallie-Anne Pearson; Katrina Spilsbury; Karen Tuesley; Susan J Jordan; Rachel E Neale

doi:10.1111/jgh.16503

Predicting the risk of pancreatic cancer in women with new-onset diabetes mellitus

J Gastroenterol Hepatol. 2024 Feb 19. doi: 10.1111/jgh.16503. Online ahead of print.

Authors

Sitwat Ali^{1

2}, Michael Coory³, Peter Donovan^{4

5}, Renhua Na², Nirmala Pandeya², Sallie-Anne Pearson⁶, Katrina Spilsbury⁷, Karen Tuesley^{1

2}, Susan J Jordan^{1

2}, Rachel E Neale^{1

2}

Affiliations

¹ School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
² Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
³ Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
⁴ Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
⁵ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁶ School of Population Health, UNSW, Sydney, New South Wales, Australia.
⁷ Centre Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.

PMID: 38373821
DOI: 10.1111/jgh.16503

Abstract

Background and aim: People with new-onset diabetes mellitus (diabetes) could be a possible target population for pancreatic cancer surveillance. However, distinguishing diabetes caused by pancreatic cancer from type 2 diabetes remains challenging. We aimed to develop and validate a model to predict pancreatic cancer among women with new-onset diabetes.

Methods: We conducted a retrospective cohort study among Australian women newly diagnosed with diabetes, using first prescription of anti-diabetic medications, sourced from administrative data, as a surrogate for the diagnosis of diabetes. The outcome was a diagnosis of pancreatic cancer within 3 years of diabetes diagnosis. We used prescription medications, severity of diabetes (i.e., change/addition of medication within 2 months after first medication), and age at diabetes diagnosis as potential predictors of pancreatic cancer.

Results: Among 99 687 women aged ≥ 50 years with new-onset diabetes, 602 (0.6%) were diagnosed with pancreatic cancer within 3 years. The area under the receiver operating curve for the risk prediction model was 0.73. Age and diabetes severity were the two most influential predictors followed by beta-blockers, acid disorder drugs, and lipid-modifying agents. Using a risk threshold of 50%, sensitivity and specificity were 69% and the positive predictive value (PPV) was 1.3%.

Conclusions: Our model doubled the PPV of pancreatic cancer in women with new-onset diabetes from 0.6% to 1.3%. Age and rapid progression of diabetes were important risk factors, and pancreatic cancer occurred more commonly in women without typical risk factors for type 2 diabetes. This model could prove valuable as an initial screening tool, especially as new biomarkers emerge.

Keywords: Absolute risk; Diabetes mellitus; Pancreatic cancer; Prediction model.

Abstract

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