Diabetes and Its Relationship to Pancreatic Carcinoma

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Abstract
The mechanism of impaired glucose metabolism that develops in most patients with pancreatic cancer (PC) is obscure and the association between PC and diabetes is controversial. According to the published data, about 70% of patients with PC have an impaired glucose tolerance (IGT) or frank diabetes, whereas 30% do not. Up to 60% of the patients with IGT or diabetes show improvement in glucose metabolism after surgery, whereas other patients show only mild or no improvement. To investigate our theory that there are three types of PC: 1) PC not associated with IGT or diabetes (IGT− subtype, ∼20–30%); 2) PC associated with IGT or diabetes (IGT+ subtype, ∼70–80%), in which the abnormality improves postoperatively (IGT+/− subtype, ∼40–60%); or 3) PC associated with IGT or diabetes that does not improve after the tumor resection (IGT+/+ subtype, ∼40–60%). Methodology and Results: The review of the literature and our own experience, which is the subject of this article, suggests that the reason for impaired glucose metabolism in most patients is the alteration of islet cells, from which, in our view, cancer cells develop. There is a good possibility that the altered islet cells, and/or tumors derived from them, produce diabetogenic substances. The extent of the islet alteration (i.e., focal or diffuse) may determine whether the removal of the tumor alone can improve the metabolic alteration. The elucidation of the mechanism is of immense importance for providing an early tumor marker and for developing preventative and therapeutic modalities.