Keum NaNa, Ha Kyoung Hwa, Bao Ying, Chung Moon Jae, Kim Hyeon Chang, Giovannucci Edward L
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Cancer Causes Control. 2018 Jan;29(1):135-142. doi: 10.1007/s10552-017-0988-6. Epub 2017 Dec 2.
Whether type 2 diabetes is cause or consequence, or both, of pancreatic cancer (PaC) remains unresolved. Leveraging repeated measurements of fasting blood glucose (FBG), we examined the temporal relationship between hyperglycemia and PaC incidence.
We conducted a nested case-control study of 278 cases and 826 matched-controls from the Korean National Health Insurance Service-Health Screening Cohort. Over 11 years before index date (date of PaC diagnosis for cases), all participants had at least one FBG measurement in each of the three time windows: - 11 to - 8, - 7 to - 4, and - 3 to 0 years. Using conditional logistic regression, we estimated odds ratios(ORs) of PaC and 95% confidence intervals (CIs) for hyperglycemia in the overall period and at each interval; for major long-term patterns of FBG across the three intervals (recent-onset, medium-term, and long-standing hyperglycemia).
Higher FBG over the past 11 years was associated with an increased odds of PaC (p < .0001), with recent FBG more predictive of PaC than distant FBG. By FBG assessed in the - 3 to 0 interval, OR was 1.97 (95% CI 1.32-2.93) for 110-125 mg/dL and 3.17 (95% CI 2.09-4.80) for ≥ 126 mg/dL. By long-term patterns of FBG, compared to consistent normoglycemia, OR was 2.02 (95% CI 1.24-3.31) for long-standing hyperglycemia and 3.38 (95% CI 1.87-6.13) for recent-onset hyperglycemia. These associations were more pronounced among never-smokers than ever-smokers (p = .06).
Recent-onset hyperglycemia may be an early manifestation of undetected PaC, while long-lasting hyperglycemia may serve as a moderate etiologic factor for PaC.
2型糖尿病是胰腺癌（PaC）的病因、后果，还是两者皆是，仍未明确。利用空腹血糖（FBG）的重复测量数据，我们研究了高血糖与PaC发病率之间的时间关系。
我们对韩国国民健康保险服务-健康筛查队列中的278例病例和826例匹配对照进行了巢式病例对照研究。在索引日期（病例的PaC诊断日期）前的11年里，所有参与者在三个时间窗口中的每个窗口都至少进行了一次FBG测量：-11至-8年、-7至-4年和-3至0年。使用条件逻辑回归，我们估计了整个时期以及每个时间段内PaC的比值比（OR）和高血糖的95%置信区间（CI）；针对三个时间段内FBG的主要长期模式（近期发病、中期和长期高血糖）。
过去11年中较高的FBG与PaC几率增加相关（p <.0001），近期FBG比远期FBG更能预测PaC。通过在-3至0区间评估的FBG，110-125mg/dL时OR为1.97（95%CI 1.32-2.93），≥126mg/dL时OR为(3.17)（95%CI 2.09-4.80）。根据FBG的长期模式，与持续正常血糖相比，长期高血糖的OR为2.02（95%CI 1.24-3.31），近期发病高血糖的OR为3.38（95%CI 1. ({87})-6.13）。这些关联在从不吸烟者中比曾经吸烟者中更明显（p = 0.06）。
近期发病的高血糖可能是未被发现的PaC的早期表现，而长期高血糖可能是PaC的中度病因。
