title: Increased Serum Insulin Exposure Does Not Affect Age or Stage of Pancreatic Adenocarcinoma Diagnosis in Patients With Diabetes Mellitus.
abstract: OBJECTIVE
  In considering whether medications that increase insulin levels accelerate pancreatic adenocarcinoma (PC) development, we hypothesized that PC patients with diabetes mellitus (DM) who used exogenous insulin or insulin-stimulating medications should have an earlier age at diagnosis or present with more advanced disease.
  
  
  METHODS
  Patients enrolled in our PC registry from June 1, 2003, to May 31, 2012, were stratified according to treatment solely with insulin, insulin-stimulating medications, or insulin-independent medications. Age at PC diagnosis, PC stage, and years between DM and PC diagnoses were analyzed among the cohorts.
  
  
  RESULTS
  Of 122 DM patients (mean age, 67.4 ± 10.2 years), the mean ages at PC diagnosis within the insulin-only (n = 40), insulin-stimulating (n = 11), insulin-independent (n = 71), and non-DM (n = 321) cohorts were 68.7 ± 10.5, 69.6 ± 10.8, 66.3 ± 9.7, and 65.5 ± 10.5 years, respectively. No significant difference among the age at PC diagnosis was observed based on duration or type of DM treatment. There was no correlation between PC stage and increased insulin exposure.
  
  
  CONCLUSIONS
  Anti-DM medications that increase exposure to insulin do not appear to accelerate PC development using outcomes of mean age at PC diagnosis, PC stage, or duration between DM and PC diagnoses.
authors.affiliation: From the *Department of Internal Medicine, University of Pittsburgh Medical Center, Shadyside; and Division of †Gastroenterology, ‡Division of Gastrointestinal Surgical Oncology, Department of Surgery, and §Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: David T
authors.initials: DT
authors.lastname: Chao
authors.forename: Nilesh H
authors.initials: NH
authors.lastname: Shah
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: Nathan
authors.initials: N
authors.lastname: Bahary
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
authors.forename: Randall E
authors.initials: RE
authors.lastname: Brand
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D017668:Age of Onset; D000368:Aged; D000428:Alcohol Drinking; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000097:blood / Q000627:therapeutic use; D007328:Insulin / Q000097:blood* / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D012907:Smoking; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin