{
  "abstract": "The first report of pancreatic cancer in a patient with recent onset of diabetes was made in 1833.1 However, even today, the relationship between the two conditions remains poorly understood. Our current understanding is that there are two distinct biological phenomena in play (figure 1). Long-standing diabetes mellitus (LSDM) is associated with a modest increase in risk of developing pancreatic cancer.2 Entirely unrelated to this is the consistent and comprehensive metabolic dysregulation caused by invasive pancreatic cancer3 which leads to a slew of new-onset glycaemic abnormalities (NOGA) in the months to years preceding pancreatic cancer diagnosis (figure 1). The type of diabetes predisposing to the development of pancreatic cancer, namely, type 2 diabetes is distinctly different from the diabetes caused by the cancer, a form of pancreatogenous or type 3c diabetes.4 While both the weakly pro-carcinogenic effect of diabetes on pancreatic cancer and the profound diabetogenic effect of pancreatic cancer have clinical implications, the complex web of interactions between the two conditions (figure 1) confounds evaluation of epidemiologic data connecting them. Let us briefly examine these, starting with the second phenomenon of reverse causality first, as it has implications for discussing the results of the study published in this issue by Tan et al which concludes that optimal glycaemic control could be a strategy for primary prevention of pancreatic cancer associated with long-standing diabetes.5",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Suresh T Chari"
    }
  ],
  "title": "Diabetes and pancreatic cancer: a complex and confounding interplay",
  "uid": "20911f55-c2be-5833-858c-d7a0da6f8c95"
}