# New-onset diabetes as an emerging risk group for early detection of pancreatic cancer: current evidence, clinical challenge, and future directions

## TL;DR

New-onset diabetes in people over 50 may signal a higher risk of pancreatic cancer, offering a potential pathway for early detection.

## Contribution

This review explores NOD as a novel risk group for early PDAC detection and highlights potential biomarkers for differentiation.

## Key findings

- NOD in individuals over 50 is linked to a higher PDAC risk within 3 years of diabetes onset.
- PDAC-associated diabetes differs from T1D, T2D, and T3cD, suggesting unique biomarkers for identification.
- Ongoing clinical trials aim to stratify NOD patients for PDAC screening, potentially improving early detection.

## Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease characterized by late-stage manifestation and relative resistance to standard therapies. Challenges with early detection and a paucity of effective therapies lead to one of the lowest 5-year survival rates among all cancers. Individuals around 50 years and over presenting with new onset diabetes (NOD) have a higher risk for PDAC diagnosis within 3 years of diabetes onset compared to the rest of the population. In this review, we contextualize NOD within other types of diabetes presentations such as type 1 diabetes (T1D), type 2 diabetes (T2D), and type 3 diabetes (T3cD), unravel the bidirectional relationship between diabetes and PDAC, and highlight potential biomarkers that may distinguish PDAC-associated diabetes from other predominant types of diabetes. Although practical applications of NOD currently fall short from being clinically actionable, clinical trials are underway to stratify NOD patients with PDAC-associated diabetes. Ultimately, these efforts could offer the rationale to implement early detection screening strategies to this subgroup of PDAC patients.