The size of the pancreatic cyst is larger in patients with type 2 diabetes at the time of diagnosis, according to a new retrospective study. They also had a faster growth of the cyst following the diagnosis.¹  

The single-center study carried out a retrospective review of the medical records of adult patients, aged 65.4 years (mean), with pancreatic cysts or pancreatic cancer between 2013 and 2020 with at least one imaging modality noting a pancreatic lesion. Nearly one-quarter of the study participants were smokers, while 32% had type 2 diabetes. Women comprised 65% of the study population. Laboratory tests undertaken included HbA1c, alkaline phosphatase, creatinine, hemoglobin, carcinogenic embryonic antigen (CEA), CA 19-9 and amylase.

A total of 198 patients with a documented pancreatic cyst were reviewed, of which, 69 (34.8 %) had diabetes. The size of the pancreatic cyst was larger in patients with type 2 diabetes (2.42 cm) compared to those who did not have diabetes (1.62 cm). Also, the size of the cyst was found to increase faster in diabetic patients; 0.15 vs 0.11 cm per year, respectively. Cyst size and growth rate were similar in diabetics regardless of their glycemic status. Similarly, patients who were smokers also had an overall larger size of the cyst; 2.2 cm versus 1.81 cm, respectively. The cyst size was still larger in diabetic patients who also smoked (2.35 cm). The prevalence of pancreatic cancer was higher in patients with diabetes (6.6 %) as compared to those who did not have diabetes (2.0%).

This study has demonstrated that the pancreatic cysts were bigger in size in patients with type 2 diabetes with a faster increase in size in these individuals suggestive of the potentially aggressive nature of the cyst. Also, pancreatic cancer was more likely to occur in diabetic patients. Presently, guidelines recommend cyst surveillance aimed at high-risk features relating to cyst growth rate (>3mm per year), its morphology and involvement of the pancreatic duct or patients with intraductal papillary mucinous neoplasms (IPMNs) or mucinous cystic neoplasm (MCNs) with new-onset or worsening diabetes mellitus. But there are no recommendations for screening for diabetic patients with regards to pancreatic cysts. With advancement in imaging techniques over the years pancreatic cysts, either benign or malignant, are being diagnosed more often than before. The number of persons with type 2 diabetes is also escalating every year. In view of the fact that “diabetes mellitus type 2 is a risk factor, a manifestation and a prognostic factor for pancreatic cancer”,² this study calls for closer monitoring of patients with type 2 diabetes who have been diagnosed with a pancreatic cyst for early detection of pancreatic cancer.

References

1. Kadosh D, et al. Prevalence and growth rates of pancreatic cysts in patients with diabetes mellitus. Am J Gastroenterol. October 2021;116: p S3 doi: 10.14309/01.ajg.0000772000.00027.9f.
2. De Souza A, et al. Diabetes type 2 and pancreatic cancer: a history unfolding. JOP. 2016 Mar;17(2):144-14.