Gallstones, a cholecystectomy, chronic pancreatitis, and the risk of subsequent pancreatic cancer in diabetic patients

A population-based cohort study

Hsueh Chou Lai, I. Ju Tsai, Pei Chun Chen, Chih Hsin Muo, Jen Wei Chou, Cheng Yuan Peng, Shih Wei Lai, Fung Chang Sung, Shu Yu Lyu, Donald E. Morisky

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: The causal association between diabetes and pancreatic cancer remains unclear in Asian populations. This study examined whether gallstones, a cholecystectomy, chronic pancreatitis and the treatment of antidiabetic agents affect the risk of subsequent pancreatic cancer for patients with diabetes in a Taiwanese population. Methods: Using claims data from the universal health insurance program in Taiwan, 449,685 newly diagnosed diabetic cases among insured people from 2000 to 2003 were identified as the case group. The comparison group, matched for gender, age, and the index year of the diabetes cohort, consisted of 325,729 persons without diabetes. Pancreatic cancer incidence was measured in both groups until the end of 2008. Other risk factors associated with this cancer were also measured. Results: The incidence of pancreatic cancer in the diabetic cohort was 2-fold greater than that in the comparison group (1.46 vs. 0.71 per 10,000 person-years) with an adjusted hazard ratio (HR) of 1.75 [95 % confidence interval (CI) 1.45-2.10]. The risk slightly increased for diabetic patients with gallstones, cholecystitis, and a cholecystectomy (HR 1.92, 95 % CI 1.18-3.11), but greatly increased for those with comorbidity of chronic pancreatitis (HR 22.9, 95 % CI 12.6-41.4). Pancreatic cancer risk also increased significantly for those patients who used more insulin for treating diabetes (OR 2.20, 95 % CI 1.40-3.45). Conclusion: Our data suggest that the risk of pancreatic cancer is moderately increased in patients with diabetes, especially those using insulin therapy. The risk is greatly increased for diabetic patients with chronic pancreatitis.

Original languageEnglish
Pages (from-to)721-727
Number of pages7
JournalJournal of Gastroenterology
Volume48
Issue number6
DOIs
Publication statusPublished - Jun 2013

Fingerprint

Chronic Pancreatitis
Cholecystectomy
Gallstones
Pancreatic Neoplasms
Cohort Studies
Confidence Intervals
Population
Insulin
Cholecystitis
Incidence
Health Insurance
Taiwan
Hypoglycemic Agents
Comorbidity
Research Design
Therapeutics
Neoplasms

Keywords

  • Cholecystectomy
  • Chronic pancreatitis
  • Diabetes
  • Gallstones
  • Pancreatic cancer

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gallstones, a cholecystectomy, chronic pancreatitis, and the risk of subsequent pancreatic cancer in diabetic patients : A population-based cohort study. / Lai, Hsueh Chou; Tsai, I. Ju; Chen, Pei Chun; Muo, Chih Hsin; Chou, Jen Wei; Peng, Cheng Yuan; Lai, Shih Wei; Sung, Fung Chang; Lyu, Shu Yu; Morisky, Donald E.

In: Journal of Gastroenterology, Vol. 48, No. 6, 06.2013, p. 721-727.

Research output: Contribution to journalArticle

Lai, Hsueh Chou ; Tsai, I. Ju ; Chen, Pei Chun ; Muo, Chih Hsin ; Chou, Jen Wei ; Peng, Cheng Yuan ; Lai, Shih Wei ; Sung, Fung Chang ; Lyu, Shu Yu ; Morisky, Donald E. / Gallstones, a cholecystectomy, chronic pancreatitis, and the risk of subsequent pancreatic cancer in diabetic patients : A population-based cohort study. In: Journal of Gastroenterology. 2013 ; Vol. 48, No. 6. pp. 721-727.
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abstract = "Background: The causal association between diabetes and pancreatic cancer remains unclear in Asian populations. This study examined whether gallstones, a cholecystectomy, chronic pancreatitis and the treatment of antidiabetic agents affect the risk of subsequent pancreatic cancer for patients with diabetes in a Taiwanese population. Methods: Using claims data from the universal health insurance program in Taiwan, 449,685 newly diagnosed diabetic cases among insured people from 2000 to 2003 were identified as the case group. The comparison group, matched for gender, age, and the index year of the diabetes cohort, consisted of 325,729 persons without diabetes. Pancreatic cancer incidence was measured in both groups until the end of 2008. Other risk factors associated with this cancer were also measured. Results: The incidence of pancreatic cancer in the diabetic cohort was 2-fold greater than that in the comparison group (1.46 vs. 0.71 per 10,000 person-years) with an adjusted hazard ratio (HR) of 1.75 [95 {\%} confidence interval (CI) 1.45-2.10]. The risk slightly increased for diabetic patients with gallstones, cholecystitis, and a cholecystectomy (HR 1.92, 95 {\%} CI 1.18-3.11), but greatly increased for those with comorbidity of chronic pancreatitis (HR 22.9, 95 {\%} CI 12.6-41.4). Pancreatic cancer risk also increased significantly for those patients who used more insulin for treating diabetes (OR 2.20, 95 {\%} CI 1.40-3.45). Conclusion: Our data suggest that the risk of pancreatic cancer is moderately increased in patients with diabetes, especially those using insulin therapy. The risk is greatly increased for diabetic patients with chronic pancreatitis.",
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T1 - Gallstones, a cholecystectomy, chronic pancreatitis, and the risk of subsequent pancreatic cancer in diabetic patients

T2 - A population-based cohort study

AU - Lai, Hsueh Chou

AU - Tsai, I. Ju

AU - Chen, Pei Chun

AU - Muo, Chih Hsin

AU - Chou, Jen Wei

AU - Peng, Cheng Yuan

AU - Lai, Shih Wei

AU - Sung, Fung Chang

AU - Lyu, Shu Yu

AU - Morisky, Donald E.

PY - 2013/6

Y1 - 2013/6

N2 - Background: The causal association between diabetes and pancreatic cancer remains unclear in Asian populations. This study examined whether gallstones, a cholecystectomy, chronic pancreatitis and the treatment of antidiabetic agents affect the risk of subsequent pancreatic cancer for patients with diabetes in a Taiwanese population. Methods: Using claims data from the universal health insurance program in Taiwan, 449,685 newly diagnosed diabetic cases among insured people from 2000 to 2003 were identified as the case group. The comparison group, matched for gender, age, and the index year of the diabetes cohort, consisted of 325,729 persons without diabetes. Pancreatic cancer incidence was measured in both groups until the end of 2008. Other risk factors associated with this cancer were also measured. Results: The incidence of pancreatic cancer in the diabetic cohort was 2-fold greater than that in the comparison group (1.46 vs. 0.71 per 10,000 person-years) with an adjusted hazard ratio (HR) of 1.75 [95 % confidence interval (CI) 1.45-2.10]. The risk slightly increased for diabetic patients with gallstones, cholecystitis, and a cholecystectomy (HR 1.92, 95 % CI 1.18-3.11), but greatly increased for those with comorbidity of chronic pancreatitis (HR 22.9, 95 % CI 12.6-41.4). Pancreatic cancer risk also increased significantly for those patients who used more insulin for treating diabetes (OR 2.20, 95 % CI 1.40-3.45). Conclusion: Our data suggest that the risk of pancreatic cancer is moderately increased in patients with diabetes, especially those using insulin therapy. The risk is greatly increased for diabetic patients with chronic pancreatitis.

AB - Background: The causal association between diabetes and pancreatic cancer remains unclear in Asian populations. This study examined whether gallstones, a cholecystectomy, chronic pancreatitis and the treatment of antidiabetic agents affect the risk of subsequent pancreatic cancer for patients with diabetes in a Taiwanese population. Methods: Using claims data from the universal health insurance program in Taiwan, 449,685 newly diagnosed diabetic cases among insured people from 2000 to 2003 were identified as the case group. The comparison group, matched for gender, age, and the index year of the diabetes cohort, consisted of 325,729 persons without diabetes. Pancreatic cancer incidence was measured in both groups until the end of 2008. Other risk factors associated with this cancer were also measured. Results: The incidence of pancreatic cancer in the diabetic cohort was 2-fold greater than that in the comparison group (1.46 vs. 0.71 per 10,000 person-years) with an adjusted hazard ratio (HR) of 1.75 [95 % confidence interval (CI) 1.45-2.10]. The risk slightly increased for diabetic patients with gallstones, cholecystitis, and a cholecystectomy (HR 1.92, 95 % CI 1.18-3.11), but greatly increased for those with comorbidity of chronic pancreatitis (HR 22.9, 95 % CI 12.6-41.4). Pancreatic cancer risk also increased significantly for those patients who used more insulin for treating diabetes (OR 2.20, 95 % CI 1.40-3.45). Conclusion: Our data suggest that the risk of pancreatic cancer is moderately increased in patients with diabetes, especially those using insulin therapy. The risk is greatly increased for diabetic patients with chronic pancreatitis.

KW - Cholecystectomy

KW - Chronic pancreatitis

KW - Diabetes

KW - Gallstones

KW - Pancreatic cancer

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