Diabetes and Pancreatic Ductal Adenocarcinoma: From Early Detection to Clinical Management

Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal gastrointestinal cancers, with a rising global incidence; indeed, the worldwide burden of pancreatic cancer has doubled over the past 25 years. Despite extensive research and advances in diagnostics and treatment, the prognosis for PDAC remains poor, with a 5-year survival rate of only 5–10%. The link between pancreatic cancer and diabetes mellitus has been recognized for decades. Approximately one patient in one hundred individuals with new-onset diabetes is diagnosed with PDAC within three years of their diabetes diagnosis. Furthermore, one in four patients diagnosed with PDAC had a prior diagnosis of diabetes mellitus. Various types of diabetes are associated with PDAC. Type 2 diabetes mellitus is the most common, characterized by increased insulin production and insulin resistance. In contrast, secondary diabetes, such as that resulting from chronic alcoholic pancreatitis, is marked by decreased insulin secretion and normal insulin sensitivity. Paraneoplastic Type 3c diabetes mellitus is typically associated with both decreased insulin production and increased insulin resistance.New-onset diabetes or prediabetes in individuals over sixty can be an early symptom of PDAC, particularly when accompanied by significant unintended weight loss. Several scoring systems, such as the END-PAC score, have been proposed to evaluate the association between new-onset diabetes and PDAC, often utilizing artificial intelligence for modelling. Additionally, the rapid deterioration of pre-existing diabetes is an emerging area of clinical interest.Despite recent progress, many aspects of this relationship remain poorly understood. This Research Topic aims to foster a comprehensive discussion on the complex and bidirectional association between PDAC and diabetes mellitus, with the goal of advancing knowledge and improving patient outcomes. It seeks to highlight current evidence, emerging diagnostic strategies, risk stratification tools, and translational approaches that may improve early detection and clinical management in this field.The scope of this Research Topic encompasses the epidemiological, clinical, pathophysiological, and diagnostic links between PDAC and diabetes, with particular attention to new-onset diabetes, prediabetes, and worsening glycemic control as possible indicators of underlying malignancy. We welcome original research articles, reviews, clinical trials, methodological articles, and perspectives addressing, but not limited to, the following themes:• PDAC-associated diabetes and paraneoplastic diabetes• New-onset diabetes as an early manifestation of PDAC• Prediabetes, weight loss, and clinical warning signs of PDAC• Type 2 diabetes, secondary diabetes, and Type 3c diabetes mellitus in relation to PDAC• Risk stratification models, including END-PAC and related scoring systems• Artificial intelligence and predictive modelling in PDAC detection• Rapid deterioration of pre-existing diabetes as a marker of pancreatic cancer• Mechanistic studies on insulin secretion, insulin resistance, and tumor-related metabolic changes• Clinical pathways for earlier diagnosis and improved patient outcomes Topic editors: Jan Bures, Jan Skrha, Miroslav Zavoral Source: https://www.frontiersin.org/research-topics/80371/diabetes-and-pancreatic-ductal-adenocarcinoma-from-early-detection-to-clinical-management