Prediabetes Remission and the Subsequent Risk of Pancreatic Cancer: A Nationwide Cohort Study.

Introduction: Prediabetes is associated with an increased risk of pancreatic cancer; however, whether prediabetes remission is associated with a reduced risk of pancreatic cancer remains unclear. This study aimed to evaluate the association between prediabetes remission or persistence and the subsequent risk of pancreatic cancer.

Methods: This nationwide cohort study included 6,058,662 adults without diabetes or cancer who underwent two consecutive national health screenings in 2009 (S1) and 2011 (S2). Changes in prediabetes status were categorized as persistent prediabetes, prediabetes remission, new-onset prediabetes, and stable normoglycemia. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for pancreatic cancer incidence were estimated using Cox proportional hazards models. Data were collected in 2022 and analyzed in 2023.

Results: During a median follow-up of 6.4 years (38.6 million person-years), 7,698 participants were newly diagnosed with pancreatic cancer. Compared to stable normoglycemia, persistent prediabetes was associated with the highest risk of pancreatic cancer (aHR, 1.28; 95% CI, 1.20-1.37), followed by new-onset prediabetes (aHR, 1.07; 95% CI, 1.01-1.15). Conversely, prediabetes remission was not significantly associated with an elevated risk of pancreatic cancer (aHR, 1.02; 95% CI, 0.96-1.10). Similar findings were observed in both men and women.

Conclusions: Individuals with persistent prediabetes had a significantly increased risk of pancreatic cancer; however, individuals who achieved prediabetes remission did not exhibit an increased risk. Promoting prediabetes remission may serve as a potential approach to help reduce the growing burden of pancreatic cancer.