Elevated Fasting Blood Sugar is Associated with Increased Risk of Pancreatic Cancer Even in the Prediabetic Range Pancreatic adenocarcinoma is a most lethal cancer with increasing incidence rate in recent years. Previous epidemiologic studies had linked type 2 diabetes to pancreatic adenocarcinoma, but studies examining the association between blood glucose and pancreatic cancer yielded, however, inconsistent results. In light of this, Dr. Wei-Chih Liao, an attending physician at the NTU hospital, conducted a systematic review and dose-response meta-analysis on the relation between blood glucose concentration and risk of pancreatic cancer, which was published by the BMJ on January 2, 2015. The analysis showed that the rate of pancreatic adenocarcinoma increases linearly with rising fasting blood glucose across both prediabetes and diabetes. This study is part of Dr. Liao’s PhD work supervised by associate professor Dr. Yu-Kang Tu and professor Dr. Kuo-Liong Chien, both at the Institute of Epidemiology & Preventive Medicine, College of Public Health. Nine observational studies, with a total of 2,408 pancreatic cancer patients among 2,989,500 individuals, were included for this meta-analysis. Random-effects dose-response meta-analysis was conducted to explore potential linear and nonlinear dose-response relations between blood glucose and rate of pancreatic cancer. There was a strong linear relation between fasting blood glucose and the rate of pancreatic cancer across both pre-diabetes and diabetes, without significant nonlinear association. The pooled pancreatic cancer rate ratio per 10 mg/dL increase in fasting blood glucose was 1.14 (95% confidence interval: 1.06 to 1.22, P<0.001) across blood glucose range between 73.9 mg/dL and 191 mg/dL. Sensitivity analysis excluding blood glucose categories in the range of diabetes showed similar results (pooled rate ratio per 10 mg/dL increase in fasting blood glucose: 1.15, 95% confidence interval: 1.05 to 1.27, P=0.003), strengthening the association between pre-diabetes and pancreatic cancer. There was no significant heterogeneity or outlying studies. The results of gender-specific analyses were in line with those of main analyses combining both genders, also showing a linear dose-response relation. In conclusion, every 10 mg/dL increase in fasting blood glucose is associated with a 14% increase in the rate of pancreatic cancer on average. Pre-diabetes is also a risk factor for pancreatic cancer and provides an opportunity for prevention of pancreatic cancer. As prediabetes precedes type 2 diabetes by years and can be improved or reversed through lifestyle changes, pre-diabetes may be an important window of opportunity for pancreatic cancer prevention. Reference Wei-Chih Liao, Yu-Kang Tu, Ming- Shiang Wu, Jaw-Town Lin, Hsiu- Po Wang, Kuo-Liong Chien. Blood glucose concentration and risk of pancreatic cancer: systematic review and dose-response metaanalysis BMJ 2015; 349:g7371. DOI: http://dx.doi.org/10.1136/bmj.g7371 Associate Professor Yu-Kang Tu Institute of Epidemiology and Preventive Medicine yukangtu@ntu.edu.tw Professor Kuo-Liong Chien Department of Internal Medicine, Institute of Epidemiology and Preventive Medicine klchien@ntu.edu.tw