# Pancreatic Cystic Neoplasm Risk Among Individuals With Diabetes

## TL;DR

Longer diabetes duration increases the risk of pancreatic cystic neoplasms, especially in younger males and current smokers.

## Contribution

Identifies diabetes duration as a novel risk factor for pancreatic cystic neoplasms in a large Korean cohort.

## Key findings

- Longer diabetes duration (≥5 years) was associated with a 1.37-fold increased risk of pancreatic cysts.
- Younger individuals (<60 years) with diabetes had a higher risk compared to older counterparts.
- Current smokers with diabetes had a 1.40-fold increased risk of pancreatic cysts.

## Abstract

Is diabetes associated with an increased risk of developing pancreatic cystic neoplasms (PCNs)?

In this cohort study of 3 856 676 individuals in Korea followed up for a median of 10 years, longer diabetes duration (≥5 years) was associated with an increased risk of PCNs after adjustment for major confounding factors. This risk was particularly elevated in individuals aged younger than 60 years with diabetes, males with diabetes, and current smokers with diabetes.

These findings suggest that diabetes may be a factor in the development of PCNs and highlight the potential need for targeted surveillance in individuals with diabetes.

This cohort study examines the association between diabetes status and risk of pancreatic cystic neoplasm development among Korean adults.

With advancements in imaging technology and more frequent health evaluations, the incidence and prevalence of pancreatic cysts have gradually increased. Certain types of pancreatic cystic neoplasms are precancerous lesions associated with an increased risk of pancreatic cancer. Hence, identifying risk factors and preventing their occurrence are crucial. Nonetheless, population-based research on modifiable risk factors remains lacking.

To investigate the association of diabetes and related factors with risk of developing pancreatic cysts.

This population-based cohort study included adults (aged ≥20 years) who underwent health examinations in 2009 through medical institutions designated by the Korean National Health Insurance Service. Participants were followed up until December 31, 2020. Data were analyzed from March 23, 2023, to February 8, 2024.

All participants were categorized according to diabetes status as having normoglycemia, impaired fasting glucose, shorter diabetes duration (<5 years), or longer diabetes duration (≥5 years). Demographic characteristics, lifestyle factors, and comorbidities at the time of health examinations were investigated.

Adjusted hazard ratios (AHRs) for pancreatic cyst occurrence for each diabetes status group were estimated using Cox proportional hazards regression models, adjusting for potential confounders.

Among the entire study population of 3 856 676 adults (mean [SD] age, 47.1 [14.0] years; 54.5% male), 330 138 (8.6%) had diabetes. The median observation period was 10.3 (IQR, 10.1-10.6) years. A total of 31 877 patients (0.8%) developed pancreatic cysts during the observation period. Compared with individuals with normoglycemia, AHRs for the development of pancreatic cysts were 1.06 (95% CI, 1.03-1.08) for those with impaired fasting glucose, 1.23 (1.18-1.28) for those with a shorter diabetes duration, and 1.37 (1.31-1.44) for those with a longer diabetes duration. Subgroup analyses showed higher AHRs for pancreatic cyst occurrence associated with diabetes among individuals younger than 60 years (AHR, 1.34 [95% CI, 1.27-1.40]), males (AHR, 1.32 [95% CI, 1.26-1.38]), and current smokers (AHR, 1.40 [95% CI, 1.30-1.51]) with diabetes compared with patients 60 years or older (AHR, 1.21 [95% CI, 1.16-1.27]), females (AHR, 1.20 [95% CI, 1.15-1.26]), never smokers (AHR, 1.22 [95% CI, 1.18-1.28]), and former smokers (AHR, 1.25 [95% CI, 1.16-1.35]) with diabetes.

In this cohort study of 3 856 676 Korean adults, longer diabetes duration was associated with an increased risk of pancreatic cysts. The risk of pancreatic cyst occurrence was higher among younger male individuals with diabetes compared with their counterparts. Smoking cessation was associated with a lower risk of pancreatic cysts. Further studies incorporating imaging and longitudinal data are needed to clarify the clinical significance of pancreatic cysts in individuals with diabetes.