背景:长期糖尿病(糖尿病)患者血糖控制的恶化可能是胰腺癌的一个可能指标。然而,糖尿病恶化与胰腺癌之间的关联程度很少受到关注.
方法:我们进行了一项配对队列研究,嵌套在基于人群的澳大利亚糖尿病女性队列中。患有不稳定糖尿病的女性,定义为药物稳定使用2年后的药物变化,按出生年份与患有稳定糖尿病的人相匹配,以1:4的比例。我们使用灵活的参数生存模型来估计风险比(HR)和95%置信区间(CI)。
结果:我们纳入了不稳定和稳定糖尿病队列中的134,954和539,789名女性,分别(平均年龄68岁)。总的来说,诊断出1,315例胰腺癌。稳定糖尿病的恶化与胰腺癌风险增加2.5倍相关(HR2.55;95%CI2.29-2.85)。在糖尿病恶化后的第一年内,风险特别高。3个月时的HR,6个月和1年分别为:5.76(95%CI4.72-7.04);4.56(95%CI3.81-5.46);和3.33(95%CI2.86-3.89),分别。7年后,风险不再显着不同。
结论:先前稳定的糖尿病患者的血糖控制恶化可能是胰腺癌的一个指标,建议对胰腺进行检查可能是合适的。糖尿病恶化与胰腺癌之间的长期(3-7年)关系较弱,这可能表明血糖控制不佳可能是胰腺癌的危险因素。
BACKGROUND: Deterioration of glycaemic control in people with long-standing diabetes mellitus (diabetes) may be a possible indicator of pancreatic cancer. However, the magnitude of the association between diabetes deterioration and pancreatic cancer has received little attention.
METHODS: We conducted a matched cohort study, nested within a population-based cohort of Australian women with diabetes. Women with unstable diabetes, defined as a change in medication after a 2-year period of stable medication use, were matched by birth year to those with stable diabetes, in a 1:4 ratio. We used flexible parametric survival models to estimate hazard ratios (HRs) and 95% confidence intervals (CI).
RESULTS: We included 134,954 and 539,789 women in the unstable and stable diabetes cohorts, respectively (mean age 68 years). In total, 1,315 pancreatic cancers were diagnosed. Deterioration of stable diabetes was associated with a 2.5-fold increased risk of pancreatic cancer (HR 2.55; 95% CI 2.29-2.85). The risk was particularly high within the first year after diabetes deteriorated. HRs at 3 months, 6 months and 1 year were: 5.76 (95% CI 4.72-7.04); 4.56 (95% CI 3.81-5.46); and 3.33 (95% CI 2.86-3.89), respectively. The risk was no longer significantly different after 7 years.
CONCLUSIONS: Deterioration in glycaemic control in people with previously stable diabetes may be an indicator of pancreatic cancer, suggesting investigations of the pancreas may be appropriate. The weaker longer-term (3-7 years) association between diabetes deterioration and pancreatic cancer may indicate that poor glycaemic control can be a risk factor for pancreatic cancer.