title: Association of diabetes mellitus and pancreatic adenocarcinoma: a meta-analysis of 88 studies.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced, incurable stage. Previous epidemiological data suggests that diabetes mellitus (DM) is a risk factor for PDAC, which may be important in early detection. However, the strength of this association needs to be determined, taking into account a number of recently published studies.
  
  
  METHODS
  A systematic review of the association between DM and PDAC was undertaken by searching electronic databases and journal references from 1973 to 2013. Summary estimates were obtained separately for case-control and cohort studies by means of a 'random effects' approach. Data pertaining to the DM was recorded and plotted at both an individual and study level, with the relative risks (RR) pooled separately to determine the relationship of DM duration and PDAC.
  
  
  RESULTS
  A total of 88 independent studies, including 50 cohort and 39 case-control studies were examined. The overall summary-combined RR was 1.97 (95 % CI 1.78-2.18) with marked heterogeneity that could not be clearly attributed to any subgroup analyses. The risk of PDAC was greatest early after the diagnosis of DM but remained elevated long after the diagnosis. The individual-level RR ranged from 6.69 at less than 1 year to 1.36 at 10 years.
  
  
  CONCLUSIONS
  The results demonstrate a strong association between PDAC and recently diagnosed DM, which may be attributed to a paraneoplastic effect. However, the presence of diabetes also remains a modest risk factor for the development of PDAC long-term. Selective screening of patients with new-onset DM for PDAC needs to be considered.
authors.affiliation: Department of Surgery, University of Melbourne, Austin Health, LTB 8, 145 Studley Rd, Heidelberg, Melbourne, VIC, 3084, Australia.
authors.forename: Pikli
authors.initials: P
authors.lastname: Batabyal
authors.forename: Stephen
authors.initials: S
authors.lastname: Vander Hoorn
authors.forename: Christopher
authors.initials: C
authors.lastname: Christophi
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology*; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000209:etiology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000209:etiology*; D011379:Prognosis