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