Original Article

Type 2 diabetes mellitus and survival in pancreatic adenocarcinoma

A retrospective cohort study

  1. Allen Hwang MD MSCE1,
  2. Vivek Narayan MD2,
  3. Yu-Xiao Yang MD MSCE3,†,*

Article first published online: 1 AUG 2012

DOI: 10.1002/cncr.27731

Issue

Cancer

Cancer

Volume 119, Issue 2, pages 404–410, 15 January 2013

Additional Information

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

Author Information

  1. 1

    Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania

  2. 2

    Department of Medicine, Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania

  3. 3

    Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania

  1. †

    Fax: (215) 349-5915;

*Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, 722 Blockley Hall, Philadelphia, PA 19104

  1. †

    Fax: (215) 349-5915;

Publication History

  1. Issue published online: 4 JAN 2013
  2. Article first published online: 1 AUG 2012
  3. Manuscript Accepted: 11 JUN 2012
  4. Manuscript Revised: 7 MAY 2012
  5. Manuscript Received: 27 MAR 2012

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Keywords:

  • pancreatic cancer;
  • type 2 diabetes mellitus;
  • prognosis;
  • survival;
  • epidemiology

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

Long-term pre-existing T2DM is associated with increased mortality in patients diagnosed with PAC. Cancer 2013. © 2012 American Cancer Society.

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