TOPLINE

Among adults aged 60 years or older with new-onset diabetes and unexplained weight loss, only about a quarter had referrals for suspected pancreatic cancer and only 10.0% underwent abdominal imaging.

METHODOLOGY

• Using data from 781 UK primary care practices, researchers conducted a retrospective cohort study including 180,815 patients with diabetes (median age at diagnosis, 60 years; 55.9% men) diagnosed between January 2015 and May 2021.
• Patients were stratified into two age groups: those aged 18-59 years (below the National Institute for Health and Care Excellence referral threshold; n = 88,605) and those aged 60 years or older (n = 92,210).
• Data on pancreatic cancer diagnoses after diabetes diagnoses were extracted.
• Outcomes assessed included the proportion of individuals with new-onset diabetes and unexplained weight loss who received referrals for suspected pancreatic cancer and underwent abdominal imaging (ultrasound scan [USS] or CT scans) within 12 months before or after the diagnosis of diabetes.
• The researchers also assessed the completeness of body weight and A1c data recorded in electronic healthcare records (EHRs) for individuals with diabetes.

TAKEAWAY

• Overall, pancreatic cancer was diagnosed in 0.3% of individuals following the diagnosis of diabetes: 0.1% in those younger than 60 years and 0.5% in those aged 60 years or older.
• Unexplained weight loss within 12 months before or after the diagnosis of diabetes was recorded in 1.3% of individuals, of whom 21.6% had a code indicating a referral for suspected pancreatic cancer.
• Among patients aged 60 years or older, 26.4% had a code indicating a referral for suspected pancreatic cancer, 10.0% had a code for abdominal imaging (6.9% USS and 3.8% CT scans), and 2.8% had pancreatic cancer recorded in their EHRs.
• Within 12 months before and after the diagnosis of diabetes, 84.2% of all patients had one or more body weight measurements and 89.4% had one or more A1c measurements recorded; for two or more measurements, the proportion decreased to 64.3% and 85.4% for body weight and A1c, respectively.

IN PRACTICE

"[The] study demonstrated opportunities to improve referral rates for people with NOD [new-onset diabetes] and weight loss. It suggested potential underutilisation of NICE [National Institute for Health and Care Excellence] referral guidelines and a possible gap in care and data quality," the researchers wrote.

SOURCE

The study was led by Agnieszka Lemanska, School of Public Health, Imperial College London, London, England. It was published online on August 18, 2026, in BMJ Open.

LIMITATIONS

The study used routine primary care coding; hence, cases may have been underrecorded or dated imprecisely. Data were not linked to secondary care or cancer registry. Reasons for referrals or non-referrals by the clinicians were not captured.

DISCLOSURES

The study received support from the National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre. One author reported receiving funding through the NIHR Development and Skills Enhancement Award within the Cancer Research Transatlantic fund and serving as the lead evaluator for the NHS England case finding pilot without receiving funding for this role. Another author disclosed being on the expert advisory panel, and a third author reported receiving diabetes-related research funding from Eli Lilly, Novo Nordisk, and Sanofi.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.