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DIABETES MELLITUS TYPE 2 IN PANCREATIC CANCER
Surgical Clinics of North America June 2013
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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%.
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Risk factors
• Modifiable1. Cigarette smoking2. Obesity3. Type 2 diabetes mellitus
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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
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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
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Relation between pancreatic cancer and diabetes
• 80% of patients will have DM2 or glucose intolerance.
• Inciting event unknown DM2 vs. Pancreatic cancer.
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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.
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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
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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
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Diabetogenic carcinoma?
• In a study of 101 patients undergoing pancreatectomy with 41% preoperative DM2.
• Postoperatively 20 % developed DM2.• 35% had improvement in sugar control.
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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.
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• THANK YOU