**7. Risk groups of diabetic patients suggested for screening of sporadic pancreatic cancer**

Early diagnosis and subsequent successful treatment of SPC associated with diabetes depends on proper evaluation of the **risk groups** of patients >50 years of age:

	- **a.** With decreasing body weight (>2 kg) and anorexia as the only clinical symptom
	- **b.** With failure of introductory antidiabetic drug therapy during the first 3 months and stagnation or a decrease in body weight (>2 kg)
	- **c.** With persistent impairment of glucose homeostasis despite the additional of a second antidiabetic drug during the next 3 months or a decrease in body weight (>2 kg)

In patients from the first group, the new-onset diabetes and the loss of body weight may be **early symptoms** of SPC. In the second group, long-term diabetes and obesity are **risk factors** for SPC [76]. A decline in diabetes control, as measured by glycated hemoglobin HbA1c, may precede clinical detection of pancreatic cancer by several months up to 5 years [77]. The failure of the antidiabetic drug treatment characterized by either poor or worsening diabetes control is a common feature of both T3c and T2 diabetic patients with pancreatic cancer [21]. Sometimes the fluctuations of blood glucose confirm unstable diabetes regardless of intensified insulin treatment. The findings of (1) worsening diabetes control and (2) failure of antidiabetic drug treatment indicate the need for SPC screening. Patients in both risk groups (i.e., new-onset and long-term diabetes) should be examined according to the structured protocol we described earlier [2].
