Diabetes mellitus type 2 in pancreatic cancer
Diabetes mellitus type 2 (DM2) is a significant risk factor for pancreatic cancer and the relationship between the two conditions is complex. DM2 occurs in 80% of patients with pancreatic cancer and new onset DM2 may be an early indicator of underlying pancreatic malignancy, with 1% of newly diagnosed DM2 cases found to have pancreatic cancer within 3 years. The pathways that cause DM2 and pancreatic tumorigenesis are intertwined, as pancreatic cancer cells can alter glucose metabolism and insulin resistance, potentially contributing to the development of DM2. DM2 also increases risks associated with pancreatic cancer resection surgery and reduces long term survival rates. Further research is needed to better understand the relationship between these conditions.
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Diabetes mellitus type 2 in pancreatic cancer
- 1. DIABETES MELLITUS TYPE 2 IN PANCREATIC CANCER Surgical Clinics of North America June 2013
- 2. Introduction • Pancreatic cancer – 4th leading cause of cancer deaths. • Estimated OS – 5% at 5 years. • 15-20% have resectable disease at presentation. • 5 year survival after resection – 25%.
- 3. Risk factors • Modifiable 1. Cigarette smoking 2. Obesity 3. Type 2 diabetes mellitus
- 4. Diagnosis of DM2 TEST CUT-OFF VALUE Fasting plasma glucose ≥ 126 mg/dL Glucose tolerance test ≥ 200 mg/dL HbA1c ≥ 6.5 % Random plasma glucose ≥ 200 mg/dL
- 5. Anatomy of islet cells • Ellipsoid clusters of cells embedded in exocrine tissue. • Receive 20-30% of the pancreatic blood flow. • Mostly concentrated in the tail
- 7. Relation between pancreatic cancer and diabetes • 80% of patients will have DM2 or glucose intolerance. • Inciting event unknown DM2 vs. Pancreatic cancer.
- 8. DM2 as a symptom • Studies show that new onset DM2 was more common in patients with pancreatic cancer than controls. • 50% greater risk of malignancy in recently diagnosed DM2 compared to long standing DM2. • One percent of newly diagnosed DM2 will be diagnosed with pancreatic cancer within 3 years. • Potential early tool for screening. • 71% of the glucose intolerance diagnosed was unknown before pancreatic cancer was diagnosed.
- 9. Insulin resistance Increased b cell mass High local levels of insulin Mitogenic action- tumor progression Pancreatic cancer cells Altered gene expression in skeletal muscles Altered gene expression TCA cycle mediators and glucose metabolism Aberrant metabolism leading to DM2
- 10. DM2 and pancreatic resection • DM2 increases operative complications • Insulin dependent DM2 increased 90 day mortality from 4.8% to 13 %. • Post operative pancreatic fistula- Odds ratio 4.3. • Reduced survival especially in new onset DM2 after resection
- 11. Diabetogenic carcinoma? • In a study of 101 patients undergoing pancreatectomy with 41% preoperative DM2. • Postoperatively 20 % developed DM2. • 35% had improvement in sugar control.
- 12. Summary • Pathways of tumourogensis of and pathophysiology of DM2 are intertwined. • Further studies required for better understanding. • DM2 is a significant co-morbidity for pancreatic resection.
- 13. • THANK YOU