2022 Grantee: Suresh Chari, MD
MD Anderson Cancer Center
Research Project: Retrospective Cohort (REGARD) and Case-Control (PANDORA) Studies for Individuals with New-onset Diabetes (NOD) and New-onset Prediabetes (NOPD) in a Large Integrated Healthcare System
Award: 2022 Pancreatic Cancer Action Network Catalyst Award funded by Henry and Marilyn Taub Foundation honoring the memory of Shirley Sadoff
Award Period: July 1, 2022 – Nov. 30, 2023
Dr. Suresh Chari is a Professor in the Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, at The University of Texas MD Anderson Cancer Center. He received his MBBS medical degree from the University of Poona in India, and then completed his residency and clinical and research fellowships in India, Germany and the U.S. Dr. Chari’s work has been instrumental in identifying new-onset diabetes as a potential early symptom of pancreatic cancer. Dr. Chari is also a member of the PanCAN Scientific & Medical Advisory Board and serves as the study principal investigator for the PanCAN Early Detection Initiative.
The National Cancer Institute (NCI) has acknowledged that studying the relationship between pancreatic cancer and diabetes – both long-term Type 2 Diabetes Mellitus and new onset hyperglycemia (elevated fasting blood sugar) and diabetes – is one of the highest research priorities in pancreatic cancer. Pancreatic cancer can cause hyperglycemia and overt diabetes. At pancreatic cancer diagnosis, 25% of subjects have long-standing (more than three years’ duration) diabetes and approximately 33% have new-onset advanced hyperglycemia or diabetes; only 15% of patients with pancreatic cancer have a normal fasting glucose at diagnosis.
Based on these observations, the PanCAN Early Detection Initiative was established to determine whether imaging at the time of new-onset diabetes or hyperglycemia could lead to the earlier detection of pancreatic cancer. The first aim of Dr. Chari’s Catalyst Award project focuses on a retrospective cohort of patients treated at the Kelsey-Seybold Health System in Houston with new-onset diabetes between 2011 and 2019. Through analyzing the data and outcomes from these approximately 4,500 patients, Dr. Chari and his team seek to validate the prediction that individuals with new-onset diabetes or hyperglycemia have a six- to eight-fold increased risk of pancreatic cancer compared to the general population.
Among the individuals with new-onset diabetes or hyperglycemia, Dr. Chari and his team will also assign a numerical score known as ENDPAC (Enriching New-onset Diabetes for Pancreatic Cancer) based on the patient’s age, changes in their blood sugar and changes in their weight. These studies will aim to confirm the expected three-fold increase in pancreatic cancer risk among individuals with elevated ENDPAC scores compared to others with new-onset diabetes or hyperglycemia who have ENDPAC scores of zero or less.
The second aim of Dr. Chari’s project will also involve information from the Kelsey-Seybold database from 2011-2019. In this case, they’ll evaluate patients who have slightly elevated A1c levels (a way to measure blood sugar) that are not high enough to reach the threshold for new-onset diabetes or hyperglycemia established for the PanCAN Early Detection Initiative. In this group of patients with “prediabetes,” the investigators will determine the rate of pancreatic cancer and whether the ENDPAC scoring system can apply and provide meaningful information about the patients’ pancreatic cancer risk. Pending the results of these analyses, the project team may consider lowering the threshold of A1c levels for eligibility for the Early Detection Initiative.
The final aim of the project will look at the Kelsey-Seybold database from 2011 to 2022. Here, the research team will measure the relationship between elevation in fasting blood glucose and A1c levels, and the time between onset of either and reaching the threshold for new-onset diabetes or prediabetes. They will also develop a platform for additional discoveries and use of artificial intelligence to identify pancreatic cancer using data from electronic medical records.
Overall, Dr. Chari’s results may help refine the criteria for the PanCAN Early Detection Initiative with the goal of developing an early detection strategy based on changes in a patient’s blood sugar and other clinical features.