Comment on “Lower glycemic status was associated with pancreatic cancer risk in prediabetes”
Year: 2026
Type: letter
Abstract: Dear editor, We read with interest the recent article by Koo et al.1 which investigated the association between glycemic status and pancreatic cancer risk in a nationwide cohort. The study provides important insights into the differential impact of glucose control in individuals with and without diabetes mellitus (DM). The authors demonstrated that in patients with DM—whether newly diagnosed or longstanding—the incidence of pancreatic cancer remained high regardless of glycemic control status. This finding suggests that once overt diabetes is present, factors accompanying the diabetic state—such as hyperinsulinemia, insulin resistance, and chronic inflammation—may contribute to pancreatic carcinogenesis1. Consequently, improving glycemic control alone may not substantially mitigate pancreatic cancer risk in this population. Conversely, among individuals without DM, elevated fasting blood glucose—particularly persistent levels within the prediabetic range (100–125 mg/dL)—was associated with a increased risk of pancreatic cancer compared with consistently normal glucose levels (<100 mg/dL). These results highlight the importance of maintaining normoglycemia in non-diabetic populations as a potential preventive strategy. If available, information on fasting glucose levels closer to the time of pancreatic cancer diagnosis could further clarify two important concerns2. First, reverse causation remains a possibility, as early pancreatic cancer can induce disturbances in glucose metabolism. Prior trajectory studies have demonstrated that blood glucose often rises within the few years preceding pancreatic cancer diagnosis, suggesting that dysglycemia may be a manifestation of subclinical disease rather than a causal factor3, 4. Second, given the inherent variability of glucose measurements, reliance on fasting glucose values obtained many years before cancer onset may introduce exposure misclassification and attenuate risk estimates. Incorporating glycemic data closer to the diagnosis window, if feasible, would therefore strengthen the validity of the observed associations. This study did not receive external funding. The authors declare no conflict of interest. Approval of the research protocol: N/A. Informed consent: N/A. Registry and the registration no. of the study/trial: N/A. Animal studies: N/A. Shih-Wei Lai: Writing—original draft and writing—review and editing. Kuan-Fu Liao: Conceptualization. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
DOI: 10.1111/jdi.70294
Authors: Shih‐Wei Lai, Kuan‐Fu Liao
Institutions: China Medical University, China Medical University Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,850
OpenAlex ID: W7140107010