S90 New-Onset Diabetes Mellitus and the Risk of Pancreatic Adenocarcinoma: A Propensity Matched Population-Level Study Using Hemoglobin A1c
Notice bibliographique
Résumé
Introduction: Seminal studies have linked diabetes mellitus (DM) with pancreatic adenocarcinoma (PDAC) mostly using fasting blood glucose levels. We sought to validate the risk of PDAC in patients with new-onset DM using hemoglobin A1c levels given the difficulty in ascertaining if glucose levels used in prior studies were truly fasting. Methods: We performed a retrospective cohort study using data from TriNetX, a multi-institutional database of over 79 million patients across 49 healthcare organizations. Patients ≥18 years old with a diagnosis of DM determined by the ICD-10 codes and hemoglobin A1c ≥6.5 from 2006-2022 were included in the analysis cohort. Patients with a history of pancreatic neuroendocrine tumors, pancreas surgery, and/or PDAC before a diagnosis of DM were excluded. We assessed PDAC risk within 2 years of new-onset DM compared to a non-DM cohort after 1:1 propensity score matching for age, gender, race, tobacco, alcohol, chronic pancreatitis, exocrine pancreatic insufficiency, BMI, and family history of GI or pancreatic malignancy. PDAC risk was expressed as adjusted odds ratios (aOR) with 95% confidence intervals. Results: Of 1,152,375 patients with DM, 0.42% (n=4,883) developed PDAC (mean age 67.5 +/- 10.8 years, 56% male, 70% White). The PDAC group was older (mean age 67.5 ± 10.8 vs 58.6 ± 14.0, P< 0.0001), and had higher A1c levels (8.37% ± 2.01 vs 8.23% ± 2.01, P< 0.001), but lower BMI (29 ± 6.44 vs 32.6 ± 7.09). After propensity score matching, using hemoglobin A1c levels, patients with new-onset DM had an increased risk of PDAC compared to the non-DM cohort (aOR 2.6, 95% CI 2.45-2.76, P< 0.0001). Furthermore, patients with PDAC diagnosed after DM onset were more likely to undergo pancreatic surgery compared to those without DM (aOR 1.54, 95% CI 1.32-1.80, P< 0.0001). However, there was no difference in all-cause mortality between the DM and non-DM cohorts (aOR 0.95, 95% CI 0.89-1.007, P= 0.15). Patients with older age, male sex, history of acute pancreatitis, chronic pancreatitis, nicotine dependence, and insulin therapy at diagnosis who develop new-onset DM were at an increased risk of PDAC (Table 1). Conclusion: New-onset DM diagnosed via hemoglobin A1c is associated with an increased risk of PDAC, especially in older male patients with a history of pancreatitis, nicotine dependence, and insulin therapy for DM. Hemoglobin A1c may be more reliable than fasting blood glucose for predictive models of PDAC risk in patients with diabetes. Table 1. - Risk of PDAC in Patients with New-Onset DM Based on Demographic Parameters and Co-Morbid Conditions Variables Adjusted odds ratio 95% confidence interval P value Age groups (compared to age ≥75) 18-39 0.05 0.03-0.07 < 0.0001 40-64 0.27 0.25-0.30 < 0.0001 65-74 0.67 0.62-0.72 < 0.0001 Male sex (compared to female sex) 1.13 1.06-1.20 < 0.0001 Race (compared to White) Blacks/African American 0.92 0.83-1.01 0.11 Hispanic or Latino 0.71 0.60-0.84 < 0.0001 Asian 0.88 0.69-1.12 0.3 American Indian or Alaska Native 0.78 0.44-1.37 0.39 Comorbidities, Yes vs No Acute pancreatitis 1.4 1.10-1.79 0.005 Chronic pancreatitis 3.92 2.77-5.55 < 0.0001 Alcohol-related disorders 0.77 0.58-1.02 0.07 Nicotine dependence 1.44 1.21-1.70 < 0.0001 Exocrine pancreatic insufficiency 0.95 0.41-2.22 0.92 Insulin therapy at diagnosis of DM 2.21 1.88-2.61 < 0.0001
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».