Lower glycemic status was associated with pancreatic cancer risk in prediabetes, but not in diabetes: A nationwide cohort study.

[INTRODUCTION] Hyperglycemia or diabetes mellitus (DM) is a well-known risk factor for pancreatic cancer, but it is uncertain whether well-controlled glycemic status can affect the pancreatic cancer incidence rate.

[METHODS] This study used 2,993,519 individuals who underwent four consecutive national annual health screenings between 2009 and 2013. The study participants were divided into three groups: nondiabetes mellitus (non-DM), new-onset DM, and known DM. Each group was further subcategorized based on the fasting blood glucose (FBG) levels and use of antidiabetic medication: well-controlled (<100 mg/dL), moderately controlled (100-125), or poorly controlled (>126).

[RESULTS] During a median follow-up of 6.3 years, the incidence rate of pancreatic cancer in the non-DM group significantly increased in the moderately controlled group compared with that in the well-controlled group, regardless of whether the FBG level was recently or initially elevated. However, no dose-response relationship was observed between glucose control status and pancreatic cancer incidence, although the incidence of pancreatic cancer in the new DM and known DM groups was generally higher than that in the non-DM group.

[CONCLUSION] The pancreatic cancer incidence rate in the non-DM group significantly increased in the poorly controlled group. These findings suggest that in populations without DM, maintaining optimal glucose control may be associated with a lower risk of developing pancreatic cancer.