Annals of Surgical Oncology

, Volume 21, Issue 7, pp 2453–2462

Association of Diabetes Mellitus and Pancreatic Adenocarcinoma: A Meta-Analysis of 88 Studies

  • Pikli Batabyal
  • Stephen Vander Hoorn
  • Christopher Christophi
  • Mehrdad Nikfarjam
Pancreatic Tumors

DOI: 10.1245/s10434-014-3625-6

Cite this article as:
Batabyal, P., Vander Hoorn, S., Christophi, C. et al. Ann Surg Oncol (2014) 21: 2453. doi:10.1245/s10434-014-3625-6



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.


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.


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.


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.

Supplementary material

10434_2014_3625_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 kb)
10434_2014_3625_MOESM2_ESM.doc (85 kb)
Supplementary material 2 (DOC 85 kb)

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Pikli Batabyal
    • 1
  • Stephen Vander Hoorn
    • 2
  • Christopher Christophi
    • 1
  • Mehrdad Nikfarjam
    • 1
  1. 1.Department of SurgeryUniversity of MelbourneMelbourneAustralia
  2. 2.Statistical Consulting Centre, Department of Mathematics and StatisticsUniversity of MelbourneMelbourneAustralia