Associations Between Routinely Measured Biomarkers and Pancreatic Cancer Risk in Individuals with Type 2 Diabetes Pre- and Post-Diagnosis

Background/Objectives: Individuals with type 2 diabetes have an increased risk of pancreatic cancer (PC), yet early detection markers remain limited. We examined associations between routinely measured serum biomarkers and subsequent PC risk in this population. Methods: Using the Swedish AMORIS cohort, 101,051 individuals aged ≥50 years at diabetes diagnosis with newly diagnosed type 2 diabetes (1969–2019) were analysed. Ten biomarkers, including liver enzymes, inflammatory markers, renal function, and lipid profiles, were assessed. The primary analysis focused on measurements within ±1 year of the diabetes diagnosis (n = 13,190; Cohort 1). Sensitivity analyses considered broader windows: −3, −5, and −10 years before diagnosis to +1 year after, and from the diagnosis to the end of the follow-up (Cohorts 2–5). Multivariable Cox models adjusted for age and sex were applied. Results: During a mean follow-up of 15.9 years, 192 individuals developed PC. In primary analysis, higher alkaline phosphatase was associated with increased PC risk (HR: 1.16, 95% CI: 1.09–1.24 per 1 SD increase). Higher creatinine was associated with reduced PC risk (HR: 0.55, 95% CI: 0.36–0.83 per 1 SD increase), while haptoglobin (HR: 1.20, 95% CI: 0.97–1.49 per 1 SD increase) suggested a modest positive association. Patterns were consistent across sensitivity analyses. Conclusions: In individuals ≥ 50 years with newly diagnosed type 2 diabetes, higher ALP and lower creatinine were independently associated with increased PC risk before and after diabetes diagnosis, while haptoglobin showed a modest positive association. As these biomarkers are routine laboratory panels, their potential to support risk stratification in primary care requires further evaluation within established risk-prediction frameworks.