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Diabetes as a risk pathway towards early diagnosis and prognostication of pancreatic cancer




Evaluating diabetes as a risk pathway towards early diagnosis and prognostication of pancreatic ductal adenocarcinoma (PDAC) using the UK QResearch database

What is the aim of the study and why is it important?

In this study, we will evaluate:

(1) association between type-2 diabetes and related illnesses with pancreatic cancer,

(2) quantify referrals for pancreatic cancer scans amongst patients diagnosed with type-2 diabetes in primary care in line with NICE guidance, and

(3) identify potential markers to predict pancreatic cancer among type-2 diabetes patients diagnosed in primary care.

Despite improvements in treatment and care, pancreatic cancer remains to be a very deadly disease. This is mainly due to patients presenting at late stages of disease as it mostly shows no or vague symptoms in early stages. About 25-50% of patients who develop pancreatic cancer have diabetes. However, currently, pancreatic cancer has only been found in approximately 1% of new-onset T2DM over 3 years, and hence, there remains an important need for GPs to better identify at-risk patients. Patients with pancreatic cancer who are diagnosed at an earlier stage have more treatment options and may even be able to undergo surgery and ultimately survive longer.

How is the research being done?

We will use primary care information from QResearch – a database containing anonymised GP records of patients in England, taken over a period of over 30 years. This will be linked to hospital records, cancer registry and death records to search for individual new-onset diabetes patient characteristics (e.g. age, gender, lifestyle) that are associated with a later diagnosis of pancreatic cancer. These linkages will be used to generate estimates using standard statistical procedures to better understand how pancreatic cancer can be diagnosed earlier among type-2 diabetes patients presenting in GP clinics.

Chief Investigator

Professor Julia Hippisley-Cox and Dr Pui San Tan

Lead Applicant Organisation Name



Location of research

University of Oxford

Date on which research approved


Project reference ID


Generic ethics approval reference


Are all data accessed are in anonymised form?


Brief summary of the dataset to be released (including any sensitive data)

We will use primary care information from QResearch – linked to Hospital Episode Statistics (HES), the Cancer Registry and the Civil Registry.

Implications and Impact

This study will help better understand the association between diabetes and pancreatic cancer and identify potential opportunities for earlier detection of pancreatic cancer by GPs.

Funding Source

CRUK Centre

Public Benefit Statement

Research Team

Professor Julia Hippisley-Cox, University of Oxford

Dr Carol Coupland, University of Nottingham

Dr Pui Tan, University of Oxford

Mr Weiqi Liao, University of Oxford

Dr Ashley Clift, University of Oxford

Dr Rachael Bashford-Rogers, University of Oxford

Dr Shivan Sivakumar, University of Oxford

Dr Cesar Garriga, University of Oxford


  • Temporality of body mass index, blood tests, comorbidities and medication use as early markers for pancreatic ductal adenocarcinoma (PDAC): a nested case–control study
    Authors: Pui San Tan , Cesar Garriga, Ashley Clift, Weiqi Liao, Martina Patone, Carol Coupland, Rachael Bashford-Rogers, Shivan Sivakumar, Julia Hippisley-Cox

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Trusted Research Environment (TRE)

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