When a patient is diagnosed with Type 2 diabetes, physicians are rarely thinking of chronic pancreatitis as the cause. However, chronic pancreatitis may be more prevalent than clinicians realize.
According to the National Pancreatitis Foundation, an estimated 5 to 12 persons for every 100,000 will develop chronic pancreatitis. For those diagnosed with chronic pancreatitis, about 50% of these cases will go on to develop diabetes.
"Diabetes is so common, about 10% of the population has it," says Mark Goodarzi, MD, PhD, director of Endocrinology, Diabetes, and Metabolism at Cedars-Sinai. "When you’re looking at people with Type 2 diabetes, a few of them also have chronic pancreatitis. These incidents may seem small, but it's crucial that patients with diabetes caused by chronic pancreatitis get the right diagnosis and treatment."
"We're trying to find a way of detecting pancreatic cancer before it's too late. If we can come up with new biomarkers to detect pancreatic cancer in the early stages, we have a much better chance of curing it with surgery."
DETECT clinical trial
Investigators at Cedars-Sinai are participating in three national, multicenter clinical studies that focus on the connection between genetics, diabetes, chronic pancreatitis and pancreatic cancer.
The first study, dubbed DETECT (Diagnosis and Characterization of Pancreatogenic Diabetes Secondary to Pancreatic Cancer and Chronic Pancreatitis), focuses on early detection of pancreatogenic (Type 3c) diabetes.
The study includes three types of participants: people with Type 2 diabetes, people with chronic pancreatitis-associated diabetes and those with diabetes associated with pancreatic cancer. Goodarzi is the co-principal investigator of DETECT.
"The main goal of DETECT is to develop a diagnostic test that can distinguish diabetes caused by pancreatitis or pancreatic cancer from the more common Type 2 diabetes," Goodarzi says.
More on the research in the Goodarzi Lab at Cedars-Sinai.
NOD clinical trial
The second study, which investigators refer to as NOD (Study to Establish a New-Onset Diabetes (NOD) Cohort), aims to impact the disheartening mortality rates associated with pancreatic ductal adenocarcinoma (PDAC), the most common cancer of the pancreas.
The study is enrolling people age 50 and older who have been recently diagnosed with diabetes within the last three months. Clinicians are following these people over a three-year period to see if any of them develop pancreatic cancer. At Cedars-Sinai, NOD is led by gastroenterologist Stephen Pandol, MD, and Marc Goodman, PhD.
"Based on prior studies, we expect 85 to 100 of these individuals will develop pancreatic cancer," Goodarzi says. "Blood samples will be taken throughout the study. For those who develop pancreatic cancer, we will have their blood samples taken before the cancer became clinically evident. These samples will be used to identify new biomarkers for early detection of pancreatic cancer among patients with diabetes. This is especially needed because early diagnosis is critical to reducing the high mortality rates currently associated with pancreatic cancer."
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PROCEED clinical trial
The third study, Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED), is the first prospective, observational cohort study of chronic pancreatitis in the U.S. At Cedars-Sinai, PROCEED is led by Pandol and Christie Jeon, ScD.
PROCEED attempts to provide the most accurate and reliable estimates to date on the progression of chronic pancreatitis, as well as defining progression of the disease and testing the predictive capability of candidate biomarkers.
"With this study, the focus is looking at the natural progression of chronic pancreatitis," Goodarzi says. "We want to provide a platform for studies to develop new modalities to diagnose and treat chronic pancreatitis and prevent its complications, including diabetes."
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Identifying pancreatic cancer 'before it's too late'
While these three studies have different aims, the overarching goal is to better understand these conditions and improve treatment outcomes.
"By understanding the underlying physiology of these conditions, we can make a more accurate diagnosis and provide the proper targeted treatment," Goodarzi says. "Today, all people with the label of Type 2 diabetes receive the same kinds of treatment. However, a patient with chronic pancreatitis-associated diabetes will require insulin intervention earlier than someone who has typical Type 2 diabetes."
Ultimately, the objective of Goodarzi and his fellow Cedars-Sinai investigators is to identify these complex health problems early on, in an effort to combat mortality rates for pancreatic cancer and other conditions. According to the American Cancer Society, the five-year survival rate for all forms of pancreatic cancer is only 9%.
"We're trying to find a way of detecting pancreatic cancer before it's too late," Goodarzi says. "If we can come up with new biomarkers to detect pancreatic cancer in the early stages, we have a much better chance of curing it with surgery."