BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis, with near-identical incidence and mortality. According to the World Health Organization Globocan Database, the estimated number of new cases worldwide will rise by 70% between 2020 and 2040. There are no effective screening methods available so far, even for high-risk individuals. The prognosis of PDAC, even at its early stages, is still mostly unsatisfactory. Impaired glucose metabolism is present in about 3/4 of PDAC cases. METHODS: Available literature on pancreatic cancer and diabetes mellitus was reviewed using a PubMed database. Data from a national oncology registry (on PDAC) and information from a registry of healthcare providers (on diabetes mellitus and a number of abdominal ultrasound investigations) were obtained. RESULTS: New-onset diabetes mellitus in subjects older than 60 years should be an incentive for a prompt and detailed investigation to exclude PDAC. Type 2 diabetes mellitus, diabetes mellitus associated with chronic non-malignant diseases of the exocrine pancreas, and PDAC-associated type 3c diabetes mellitus are the most frequent types. Proper differentiation of particular types of new-onset diabetes mellitus is a starting point for a population-based program. An algorithm for subsequent steps of the workup was proposed. CONCLUSIONS: The structured, well-differentiated, and elaborately designed approach to the elderly with a new onset of diabetes mellitus could improve the current situation in diagnostics and subsequent poor outcomes of therapy of PDAC.

3rd Department of Internal Medicine Endocrinology and Metabolism 1st Faculty of Medicine Charles University Prague and General University Hospital Prague 128 08 Prague Czech Republic

Biomedical Research Centre University Hospital Hradec Kralove 500 03 Hradec Kralove Czech Republic

Department of Medicine 1st Faculty of Medicine Charles University Prague and Military University Hospital Prague 169 02 Prague Czech Republic

Department of Medicine 3rd Faculty of Medicine Charles University Prague and University Hospital Kralovske Vinohrady 100 00 Prague Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University 602 00 Brno Czech Republic

Institute of Gastrointestinal Oncology Military University Hospital Prague 169 02 Prague Czech Republic

Institute of Health Information and Statistics of the Czech Republic 128 01 Prague Czech Republic

The Royal Marsden NHS Foundation Trust London SW3 6JJ UK

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