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Type 2 diabetes mellitus and survival in pancreatic adenocarcinoma
A retrospective cohort study
Version of Record online: 1 AUG 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 2, pages 404–410, 15 January 2013
How to Cite
Hwang, A., Narayan, V. and Yang, Y.-X. (2013), Type 2 diabetes mellitus and survival in pancreatic adenocarcinoma. Cancer, 119: 404–410. doi: 10.1002/cncr.27731
- Issue online: 4 JAN 2013
- Version of Record online: 1 AUG 2012
- Manuscript Accepted: 11 JUN 2012
- Manuscript Revised: 7 MAY 2012
- Manuscript Received: 27 MAR 2012
- pancreatic cancer;
- type 2 diabetes mellitus;
Recent evidence has identified pre-existing type 2 diabetes mellitus (T2DM) as a risk factor for the development of PAC, but relatively little is known about its effects on survival. Our aim was to determine the effect of varying durations of pre-existing T2DM on survival in patients with PAC.
We conducted a retrospective cohort study using The Health Improvement Network (THIN), a primary care electronic medical record database from the UK (2003-2010). The study cohort included all subjects with a diagnostic code for PAC. Subjects with a diagnostic code for T2DM before their PAC diagnosis were classified as exposed; otherwise, subjects were classified as unexposed. The primary outcome was overall survival. The analysis was performed using univariate and multivariable Cox proportional-hazards models. Additional analysis was performed to assess the effect of increasing duration of pre-existing T2DM [i.e., <90 days, 90 days to <1 year, 1 to <3 years, 3 to 5 years, >5 years] on survival.
The study included 3,147 patients with PAC, with 745 patients having pre-existing T2DM and 2,402 patients without pre-existing T2DM. In the primary multivariate analysis, there was no difference in survival between those exposed and those unexposed to pre-existing T2DM (HR 1.02 [0.93, 1.12], p = 0.620). In the secondary analysis, only those patients with T2DM > 5 years duration had a significantly increased mortality (HR 1.16 [1.00, 1.33], p < 0.05).
Long-term pre-existing T2DM is associated with increased mortality in patients diagnosed with PAC. Cancer 2013. © 2012 American Cancer Society.