It has been unclear whether the risk of pancreatic cancer is different according to glucose levels.


To determine the association between fasting glucose levels and pancreatic cancer risk using prospectively collected nationwide population-based cohort data in Korea.


The National Health Insurance Service (NHIS) Database of Claims and preventive health check-up data recorded was used between 2009 and 2015.

Setting and Participants

A total of 25.4 million patients who had participated in a preventive health check-up between 2009 and 2013 were evaluated for pancreatic cancer incidence rates according to fasting glucose level.

Main Outcomes Measures

The cumulative incidence rate for pancreatic cancer was calculated after grouping according to fasting glucose levels as follows: 1) low normal (<90 mg/dL), 2) high normal (90-99 mg/dL), 3) prediabetes level 1 (100-109 mg/dl), 4) prediabetes level 2 (110-125 mg/dl), 5) diabetes (≥126 mg/dL), and 6) diabetes on anti-diabetic medications.


The 5-year cumulative incidence rates (per 100,000) were as follows: 1) low normal=32; 2) high normal=41; 3) prediabetes level 1=50; 4) prediabetes level 2=64; 5) diabetes=75; and 6) on anti-diabetic medications=121. The risk of pancreatic cancer increased continuously with elevating fasting glucose levels (P<0.0001). The incidence of pancreatic cancer increased significantly with increasing fasting blood glucose levels even after adjusting for age, sex, smoking, drinking, exercise, body mass index and diabetes duration (P<0.0001).


The cumulative incidence rate of pancreatic cancer significantly increased as the fasting glucose level elevated, even in populations with a normal glucose level range.

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