Need for Switch to Incretins in T2D an Indicator of Pancreatic Cancer

A retrospective analysis of evidence from prescription data gathered in Belgium and Italy has found that uncontrolled diabetes might be an early sign of pancreatic cancer—a disease that is difficult to diagnose in its early stages due to lack of symptoms.

The collaborative study, which was presented at the European Cancer Congress by Alice Koechlin, a researcher from the International Prevention Research Institute in Lyon, France, evaluated data on 368,377 patients with type 2 diabetes (T2D) in Belgium between 2008 and 2013, and 456,311 patients in Lombardy, Italy, between 2008 and 2012. During this time period, there were 885 new cases of pancreatic cancer in Belgium and 1872 new cases in Lombardy.

Koechlin told the audience that 50% of all the cases were diagnosed within a year of patients being diagnosed with, and treated for, type 2 diabetes. In Beligum, 25% of the patients were diagnosed within 90 days, while in Lombardy, the number stood at 18%.

When the authors looked at the subset of patients who were already on oral antidiabetic agents, there were signs that diabetes deteriorated faster among those who were diagnosed with pancreatic cancer. This group of patients had been prescribed injectable treatments (incretins or insulin) for better control of their T2D. The researchers identified a 7-fold increase in the risk of being diagnosed with pancreatic cancer among this group.

Koechlin told the audience that while the association between T2D and pancreatic cancer has been known, the challenge has been with identifying the cause-effect relation. Their study showed that incretin treatments are prescribed to T2D patients whose diabetes is caused by undiagnosed pancreatic cancer. She described this phenomenon as reverse causation.

“Our study also shows that the reverse causation observed for incretin drugs is also observed for other anti-diabetic therapies, in particular for insulin therapy,” Koechlin added.

Following the progress of an associated disease such as T2D in the absence of early biomarkers for the detection of pancreatic cancer—a disease that has a dismal 5-year survival rate of 8% in the United States—can help clinicians capture this disease early in patients.