title: Diabetes, plasma glucose and incidence of pancreatic cancer: A prospective study of 0.5 million Chinese adults and a meta-analysis of 22 cohort studies.
abstract: Diabetes is associated with an increased risk of pancreatic cancer (PC) in Western populations. Uncertainty remains, however, about the relevance of plasma glucose for PC among people without diabetes and about the associations of diabetes and high blood glucose with PC in China where the increase in diabetes prevalence has been very recent. The prospective China Kadoorie Biobank (CKB) study recruited 512,000 adults aged 30-79 years from 10 diverse areas of China during 2004-2008, recording 595 PC cases during 8 years of follow-up. Cox regression yielded adjusted hazard ratios (HRs) for PC associated with diabetes (previously diagnosed or screen-detected) and, among those without previously diagnosed diabetes, with levels of random plasma glucose (RPG). These were further meta-analysed with 22 published prospective studies. Overall 5.8% of CKB participants had diabetes at baseline. Diabetes was associated with almost twofold increased risk of PC (adjusted HR = 1.87, 95% CI 1.48-2.37), with excess risk higher in those with longer duration since diagnosis (p for trend = 0.01). Among those without previously diagnosed diabetes, each 1 mmol/L higher usual RPG was associated with a HR of 1.12 (1.04-1.21). In meta-analysis of CKB and 22 other studies, previously diagnosed diabetes was associated with a 52% excess risk (1.52, 1.43-1.63). Among those without diabetes, each 1 mmol/L higher blood glucose was associated with a 15% (1.15, 1.09-1.21) excess risk. In Chinese and non-Chinese populations, diabetes and higher blood glucose levels among those without diabetes are associated with an increased risk of PC.
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Yuanjie
authors.initials: Y
authors.lastname: Pang
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom.
authors.forename: Christiana
authors.initials: C
authors.lastname: Kartsonaki
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bragg
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom.
authors.forename: Ling
authors.initials: L
authors.lastname: Yang
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Bian
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom.
authors.forename: Andri
authors.initials: A
authors.lastname: Iona
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom.
authors.forename: Iona Y
authors.initials: IY
authors.lastname: Millwood
authors.affiliation: School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lv
authors.affiliation: School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Canqing
authors.initials: C
authors.lastname: Yu
authors.affiliation: National Center for Food Safety Risk Assessment, Beijing, 100021, China.
authors.forename: Junshi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, 100730, China.|School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Li
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Holmes
authors.affiliation: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Zhengming
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001786:Blood Glucose; D002681:China / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: Chinese; diabetes; pancreatic cancer; plasma glucose