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Gallstones, a cholecystectomy, chronic pancreatitis, and the risk of subsequent pancreatic cancer in diabetic patients: a population-based cohort study

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The causal association between diabetes and pancreatic cancer remains unclear in Asian populations. This study examined whether gallstones, a cholecystectomy, chronic pancreatitis and the treatment of antidiabetic agents affect the risk of subsequent pancreatic cancer for patients with diabetes in a Taiwanese population.

Methods

Using claims data from the universal health insurance program in Taiwan, 449,685 newly diagnosed diabetic cases among insured people from 2000 to 2003 were identified as the case group. The comparison group, matched for gender, age, and the index year of the diabetes cohort, consisted of 325,729 persons without diabetes. Pancreatic cancer incidence was measured in both groups until the end of 2008. Other risk factors associated with this cancer were also measured.

Results

The incidence of pancreatic cancer in the diabetic cohort was 2-fold greater than that in the comparison group (1.46 vs. 0.71 per 10,000 person-years) with an adjusted hazard ratio (HR) of 1.75 [95 % confidence interval (CI) 1.45–2.10]. The risk slightly increased for diabetic patients with gallstones, cholecystitis, and a cholecystectomy (HR 1.92, 95 % CI 1.18–3.11), but greatly increased for those with comorbidity of chronic pancreatitis (HR 22.9, 95 % CI 12.6–41.4). Pancreatic cancer risk also increased significantly for those patients who used more insulin for treating diabetes (OR 2.20, 95 % CI 1.40–3.45).

Conclusion

Our data suggest that the risk of pancreatic cancer is moderately increased in patients with diabetes, especially those using insulin therapy. The risk is greatly increased for diabetic patients with chronic pancreatitis.

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Acknowledgments

This study was supported in part by the National Science Council, Executive Yuan (Grant no. NSC 99-2621-M-039-001), China Medical University Hospital (DMR-99-119 and 1MS1), and Taiwan Department of Health Clinical Trial and Research Center of Excellence (DOH100-TD-B-111-004) and the Cancer Research Center of Excellence (DOH100-TD-C-111-005). H.-C.L. wrote the manuscript and contributed to the discussion. I.-J.T and C.-H. M researched the data. P.-C.C. researched the data and contributed to the discussion. J.-W.C., C.-Y.P., and S.-W.L. contributed to the discussion. F.-C.S. reviewed and edited the manuscript. S.-Y.L. and D.E.M. contributed to the discussion and reviewed/edited the manuscript.

Conflict of interest

None.

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Authors and Affiliations

  1. School of Chinese Medicine, China Medical University, Taichung, 404, Taiwan

    Hsueh-Chou Lai

  2. Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan

    Hsueh-Chou Lai, Jen-Wei Chou & Cheng-Yuan Peng

  3. Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan

    I-Ju Tsai, Pei-Chun Chen, Chih-Hsin Muo & Fung-Chang Sung

  4. Department of Family Medicine, China Medical University Hospital, Taichung, 404, Taiwan

    Shih-Wei Lai

  5. Department of Public Health, China Medical University College of Public Health, Taichung, 404, Taiwan

    Fung-Chang Sung

  6. School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan

    Shu-Yu Lyu

  7. Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, 90095, USA

    Donald E. Morisky

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  1. Hsueh-Chou Lai
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  2. I-Ju Tsai
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Correspondence to Shu-Yu Lyu.

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Lai, HC., Tsai, IJ., Chen, PC. et al. Gallstones, a cholecystectomy, chronic pancreatitis, and the risk of subsequent pancreatic cancer in diabetic patients: a population-based cohort study. J Gastroenterol 48, 721–727 (2013). https://doi.org/10.1007/s00535-012-0674-0

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  • DOI: https://doi.org/10.1007/s00535-012-0674-0

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