Pancreatic cancer and diabetes have been linked once again. Image from MedScape
In practice, usually its been the opposite. When a person with diabetes becomes “non-diabetic”, our first thought is a hypermetabolic process could be consuming the sugar, making him appear to be non-diabetic. However, in this study, they found a worsening of the diabetes to suggest a cancerous process was occurring.
As we discussed in previous articles regarding diabetes, https://doctordaliah.wordpress.com/2017/01/26/diabetes-now-the-third-biggest-killer-in-the-united-states/ the pancreas is the organ responsible for producing insulin, a hormone that helps blood sugar transfer to cells to keep them functional. If the pancreas undergoes any sort of injury, whether it be from an infection, trauma, or even cancer, it won’t function properly. Less insulin made, means more circulating blood sugar, or a diabetic picture.
In this study a team of researchers evaluated close to a million patients from Italy and Belgium and found 50% of those diagnosed with pancreatic cancer were diagnosed with diabetes previously that year. Use of stronger diabetic medications such as insulin injections and the incretin mimetics appeared to be associated with a higher incidence of pancreatic cancer.
They do not suggest the medications caused the cancer but rather the deteriorating status of the diabetes (requiring the stronger medications) was the cancer invading the pancreas.
One of the study authors, Ms Koechlin Autier said, “Although it has been known for some time that there is an association between type 2 diabetes and pancreatic cancer, the relationship between the two conditions is complex. Incretin therapies reduce diabetic hyperglycemia through stimulating the release of insulin by the pancreas. These drugs are typically prescribed when the oral anti-diabetic drugs can no longer control blood glucose levels. Because of their stimulating effects on the pancreas, it has long been thought that the incretin therapies could promote the occurrence of pancreatic cancer. However, it is known that pancreatic cancer can cause diabetes. Our study shows that incretin therapies are often prescribed to patients whose diabetes is caused by a still undiagnosed pancreatic cancer. Because the pancreatic cancer finally becomes symptomatic and is thus diagnosed, it looks like it is the intake of incretin drugs that could be the trigger of the pancreatic cancer, while in reality, it is the pancreatic cancer that causes a deterioration of diabetes, which is followed by the prescription of incretins. This phenomenon is called ‘reverse causation’. Our study also shows that the reverse causation observed for incretin drugs is also observed for other anti-diabetic therapies, in particular for insulin therapy.”
This “reverse causation” phenomenon can lead providers and patients to feel a medication or treatment is causing a disease when actually the disease is requiring the need for the medication/treatment.
Pancreatic cancer is very lethal and unfortunately it remains asymptomatic until it has progressed to an advanced stage. So a worsening of diabetes (in the absence of poor diet and lack of compliance with medication) may be the only sign that pancreatic cancer is occurring. The earlier the cancer is caught, the better the prognosis.
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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician