Prediabetes Remission and the Subsequent Risk of Pancreatic Cancer: A Nationwide Cohort Study

Introduction: Prediabetes is associated with an increased risk of pancreatic cancer; however, whether prediabetes remission is associated with a reduced risk of pancreatic cancer remains unclear. This study aimed to evaluate the association between prediabetes remission or persistence and the subsequent risk of pancreatic cancer. Methods: This nationwide cohort study included 6,058,662 adults without diabetes or cancer who underwent 2 consecutive national health screenings in 2009 (S1) and 2011 (S2). Changes in prediabetes status were categorized as persistent prediabetes, prediabetes remission, new-onset prediabetes, and stable normoglycemia. Adjusted hazard ratios and 95% CIs for pancreatic cancer incidence were estimated using Cox proportional hazards models. Data were collected in 2022 and analyzed in 2023. Results: During a median follow-up of 6.4 years (38.6 million person-years), 7,698 participants were newly diagnosed with pancreatic cancer. Persistent prediabetes was associated with the highest risk of pancreatic cancer than stable normoglycemia (adjusted hazard ratio=1.28; 95% CI=1.20, 1.37), followed by new-onset prediabetes (adjusted hazard ratio=1.07; 95% CI=1.01, 1.15). Conversely, prediabetes remission was not significantly associated with an elevated risk of pancreatic cancer (adjusted hazard ratio=1.02; 95% CI=0.96, 1.10). Similar findings were observed in both men and women. Conclusions: Individuals with persistent prediabetes had a significantly increased risk of pancreatic cancer; however, individuals who achieved prediabetes remission did not exhibit an increased risk. Promoting prediabetes remission may serve as a potential approach to help reduce the growing burden of pancreatic cancer.