Background: People with new-onset diabetes face higher risk of pancreatic cancer (PC). However, data on PC risk in people with more advanced stages of diabetes are lacking. We aimed to identify factors associated with PC among people with progressing diabetes.

Methods: We conducted a retrospective cohort study on veterans aged ≥50, who were treated with either combination oral hypoglycemic therapy (n=578,543) or insulin (n=609,687) at the VA in 2000-2016. Incident PC was determined through the electronic health records and cancer registries. We examined the association of multiple risk factors with PC using Cox regression analyses.

Results: In both people initiating combination therapy and in those initiating insulin, increasing age, male sex, non-Hispanic ancestry, current smoking, acute and chronic pancreatitis, abdominal pain, alcoholism, increase in A1c, and decrease in weight were associated with increased risk of PC (Table). Based on the multivariable model, we can identify sub-populations with ≥5% risk of PC, such as ≥75 year-old non-Hispanic white males initiating insulin who have a history of alcoholism, and who show ≥2% increase in A1c and ≥15% decrease in weight prior to insulin initiation.

Conclusion: We identified risk factors associated with PC among people initiating combination oral hypoglycemics or insulin, which may be useful for stratifying people who may benefit from screening for PC.


C.Y. Jeon: None. M.O. Goodarzi: None. Y. Lin: None. S. Kim: None. T. Moin: None. J.R. Pisegna: None.


National Cancer Institute (R21CA220073)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at