@article{3151567,
    title = "Diabetes mellitus, glycated haemoglobin and C-peptide levels in relation
to pancreatic cancer risk: a study within the European Prospective
Investigation into Cancer and Nutrition (EPIC) cohort",
    author = "Grote, V. A. and Rohrmann, S. and Nieters, A. and Dossus, L. and and Tjonneland, A. and Halkjaer, J. and Overvad, K. and Fagherazzi, G. and and Boutron-Ruault, M. C. and Morois, S. and Teucher, B. and Becker, S. and and Sluik, D. and Boeing, H. and Trichopoulou, A. and Lagiou, P. and and Trichopoulos, D. and Palli, D. and Pala, V. and Tumino, R. and Vineis, and P. and Panico, S. and Rodriguez, L. and Duell, E. J. and Molina-Montes, and E. and Dorronsoro, M. and Huerta, J. M. and Ardanaz, E. and Jeurnink, S. and M. and Beulens, J. W. J. and Peeters, P. H. M. and Sund, M. and Ye, W. and and Lindkvist, B. and Johansen, D. and Khaw, K. T. and Wareham, N. and and Allen, N. and Crowe, F. and Jenab, M. and Romieu, I. and Michaud, D. S. and and Riboli, E. and Romaguera, D. and Bueno-de-Mesquita, H. B. and Kaaks, and R.",
    journal = "Diabetologia",
    year = "2011",
    volume = "54",
    number = "12",
    pages = "3037-3046",
    publisher = "Springer-Verlag",
    issn = "0012-186X, 1432-0428",
    doi = "10.1007/s00125-011-2316-0",
    keywords = "C-peptide; HbA(1c); Cohort study; Diabetes; EPIC; Pancreatic cancer",
    abstract = "Aims/hypothesis There has been long-standing debate about whether
diabetes is a causal risk factor for pancreatic cancer or a consequence
of tumour development. Prospective epidemiological studies have shown
variable relationships between pancreatic cancer risk and blood markers
of glucose and insulin metabolism, overall and as a function of lag
times between marker measurements (blood donation) and date of tumour
diagnosis.
Methods Pre-diagnostic levels of HbA(1c) and C-peptide were measured for
466 participants with pancreatic cancer and 466 individually matched
controls within the European Prospective Investigation into Cancer and
Nutrition. Conditional logistic regression models were used to estimate
ORs for pancreatic cancer.
Results Pancreatic cancer risk gradually increased with increasing
pre-diagnostic HbA(1c) levels up to an OR of 2.42 (95% CI 1.33, 4.39
highest [>= 6.5%, 48 mmol/mol] vs lowest [<= 5.4%, 36 mmol/mol]
category), even for individuals with HbA(1c) levels within the
non-diabetic range. C-peptide levels showed no significant relationship
with pancreatic cancer risk, irrespective of fasting status. Analyses
showed no clear trends towards increasing hyperglycaemia (as marked by
HbA(1c) levels) or reduced pancreatic beta cell responsiveness (as
marked by C-peptide levels) with decreasing time intervals from blood
donation to cancer diagnosis.
Conclusions/interpretation Our data on HbA(1c) show that individuals who
develop exocrine pancreatic cancer tend to have moderate increases in
HbA(1c) levels, relatively independently of obesity and insulin
resistance-the classic and major risk factors for type 2 diabetes. While
there is no strong difference by lag time, more data are needed on this
in order to reach a firm conclusion."
}