Global, regional, and national analyses of the burden of pancreatic cancer attributable to high fasting plasma glucose from 1990 to 2021: A longitudinal observational study

High fasting plasma glucose (HFPG) is the second dominant metabolic risk factor contributing to the global burden of pancreatic cancer (PC). However, detailed investigations into the spatiotemporal patterns of PC burden attributable to HFPG remain limited. This study aims to assess global, regional, and national trends in PC mortality and disability-adjusted life years (DALYs) attributable to HFPG from 1990 to 2021. This longitudinal observational study was based on data from the global burden of disease 2021 study, covering data from 204 countries and territories. We extracted mortality, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) for PC attributable to HFPG. These metrics were stratified by sex, age group, country, and socio-demographic index (SDI). Temporal trends were evaluated using the estimated annual percentage change (EAPC) for ASMR and ASDR between 1990 and 2021. In 2021, an estimated 132,753 (95% uncertainty interval [UI]: 15,077-252,345) deaths and 2,751,644 (95% UI: 315,351-5,201,444) DALYs were attributable to HFPG, accounting for 40.9% and 39.3% of total PC-related deaths and DALYs, respectively. From 1990 to 2021, the number of HFPG-attributable PC deaths and DALYs increased by 234.1% and 209.7%, respectively. Substantial regional and national disparities were observed in the burden of PC attributable to HFPG. The highest ASMR and ASDR were recorded in high-SDI regions. Among global regions, East Asia reported the largest number of HFPG-attributable PC deaths and DALYs. The burden was also disproportionately higher among males and older adults. Notably, both ASMR and ASDR were significantly inversely correlated with EAPC. The global burden of PC attributable to HFPG has risen substantially over the past 3 decades, with marked regional and demographic disparities. These findings underscore the urgent need for glycemic control strategies and nutrition-based public health interventions to reduce HFPG-related cancer burden, particularly among high-risk populations.