PRISMA_2020_checklist.

<div><p>Background</p><p>Glycemic disorder is closely related to the risk of pancreatic cancer, but previous studies focused on the influence of diabetes. The aim of this meta-analysis was to investigate the influence of prediabetes, an intermediate state between normoglycemia and diabetes, on the risk of pancreatic cancer.</p><p>Methods</p><p>Relevant longitudinal observational studies were identified through a search of Medline, Embase, and Web of Science databases. To minimize the influence of between-study heterogeneity, a randomized-effects model was used to pool the results.</p><p>Results</p><p>Nine cohort studies including 26,444,624 subjects were available for the meta-analysis. Among them, 2,052,986 (7.8%) had prediabetes at baseline, and the participants were followed for a mean duration of 5.9 years. It was found that, compared to people with normoglycemia, those with prediabetes had a higher incidence of pancreatic cancer (risk ratio [RR]: 1.42, 95% confidence interval: 1.36 to 1.49, <i>p</i><0.001) with no statistical heterogeneity (I<sup>2</sup> = 0%). Sensitivity analysis performed by excluding one dataset at a time did not significantly change the results (RR: 1.38 to 1.45, <i>p</i> all <0.05). Subgroup analyses indicated that the association between prediabetes and increased risk of pancreatic cancer was not significantly impacted by study characteristics such as study design, location, age, and sex of participants, definition of prediabetes, duration of follow-up, or adjustment for alcohol intake (<i>p</i> for subgroup difference all >0.05).</p><p>Conclusions</p><p>Prediabetes may be associated with an increased risk of pancreatic cancer compared to normoglycemia.</p></div>