169
2020년 제 71차 대한내과학회 추계학술대회
￭S-126 ￭ Glycemic status, insulin resistance, and risk of pancreatic cancer mortality
in diabetic individuals
강북삼성병원 내과 김재범, 김남희, 김홍주, 전우규
Background/Aims: The impact of glycemic status and insulin resistance on the risk of pancreatic cancer in the nondiabetic population remains uncertain. We aimed to examine the association of glycemic status and insulin resistance with pancreatic cancer mortality in diabetic and nondiabetic individuals.
Methods: A cohort study of 572,021 Korean adults without cancer at baseline participated in repeat screening examinations, which included fasting blood glucose, HbA1c, and insulin, and were followed for up to 17 years. Vital status and pancreatic cancer mortality were ascertained through linkage to national death records.
Results: During 5,211,321 person-years of follow-up, 260 deaths from pancreatic cancer were identified, with a mortality rate of 5.0 per 105 person-years. In the overall population, the risk of pancreatic cancer mortality increased with increasing levels of glucose and HbA1c in a dose-response manner, and this association was observed even in nondiabetic individuals. In nondiabetic individuals without previously diagnosed or screen-detected diabetes, insulin resistance and hyperinsulinemia were positively associated with increased pancreatic cancer mortality. Specifically, the multivariable-adjusted hazard ratio (95% confidence intervals) for pancreatic cancer mortality comparing the HOMA-IR ≥75th percentile to the <75th percentile was 1.49 (1.08-2.05) and the corresponding hazard ratio comparing the insulin ≥75th percentile to the <75th percentile was 1.43 (1.05-1.95). These associations remained significant when introducing changes in insulin resistance, hyperinsulinemia and other confounders during follow-up as time-varying covariates.
Conclusions: Glycemic status, insulin resistance, and hyperinsulinemia, even in nondiabetic individuals, were independently associated with increased risk of pancreatic cancer mortality.
