Impact of good glycemic control on survival of pancreatic ductal adenocarcinoma with diabetes mellitus

While diabetes mellitus (DM) has been reported as a risk factor for development and prognosis of pancreatic ductal adenocarcinoma (PDAC), the specific impact of glycemic control on clinical outcomes remains poorly defined. Therefore, we investigated how glycemic status influences survival specifically in patients with comorbid PDAC and DM. The clinical data of PDAC patients with DM were collected via the database of Samsung Medical Center. They were categorized according to the duration of DM; long-standing DM (LSDM), new-onset DM (NODM), and type 3c DM (T3cDM). Glycemic status was assessed using hemoglobin A1c (HbA1c) levels. The effect of glycemic control on overall survival (OS) was evaluated by Kaplan-Meier method and Cox analysis. A total of 255 patients that consisted of 195 patients with HbA1c < 8% and 60 patients with HbA1c ≥ 8% were included in analysis. PDAC patients with HbA1c < 8% had better OS than those with HbA1c ≥ 8% (median OS: 2.5 years vs. 1.2 years; p = 0.0003). The LSDM group had the worst survival, while the T3cDM group had the best survival (median OS: 1.7 years vs. 7.2 years; p = 0.0027). In multivariable analysis, HbA1c ≥ 8% (HR = 1.54, 95%CI 1.07–2.17), age ≥ 65 (HR = 1.83, 95%CI 1.34–2.50), stage Ⅳ (HR = 2.04, 95%CI 1.45–2.84), and male (HR = 1.52, 95%CI 1.11–2.11) were identified as poor prognostic factors for PDAC. Good glycemic control is associated with prolonged OS in PDAC and it implies managing glycemic status could help to improve the prognosis of these patients.