{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:47:22Z","timestamp":1791618442658,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Pancreatic ductal adenocarcinoma (PDAC) remains highly lethal because most patients are diagnosed after curative treatment is no longer feasible. Diabetes mellitus and PDAC have a bidirectional relationship: long\u2010standing type 2 diabetes mellitus (T2DM) modestly increases background cancer risk, whereas new\u2010onset diabetes (NOD), particularly after 50\u00a0years of age, may represent a paraneoplastic manifestation of occult PDAC. Population\u2010based data suggest that approximately 0.6%\u20130.85% of older adults with NOD are diagnosed with PDAC within 3\u00a0years. This absolute risk is too low to justify universal imaging, but high enough to support phenotype\u2010based triage. This review clarifies the distinction among T2DM, PDAC\u2010associated diabetes, type 3c diabetes mellitus related to non\u2010malignant exocrine pancreatic disease, and post\u2010pancreatectomy dysglycemia. We also summarise epidemiological and biological evidence connecting dysglycemia with PDAC, including insulin resistance, hyperinsulinemia, impaired insulin secretion, cachexia\u2010related metabolic change, and exocrine\u2010endocrine crosstalk. Particular emphasis is placed on selective diagnostic escalation. Age at diabetes onset, unintended weight loss, HbA1c or glucose trajectory, insulin resistance indices, biomarkers, and risk\u2010enrichment models, including the Enriching New\u2010Onset Diabetes for Pancreatic Cancer (END\u2010PAC) model, should be interpreted together rather than in isolation. Pancreas\u2010protocol computed tomography remains the first\u2010line diagnostic study when PDAC is suspected, while magnetic resonance imaging and endoscopic ultrasonography play complementary roles. We further discuss implications for pancreatic surgery, perioperative metabolic care, postoperative dysglycemia, and lessons from high\u2010risk surveillance cohorts. A diabetes\u2010centred framework may improve early recognition without promoting indiscriminate screening.<\/jats:p>","DOI":"10.1002\/dmrr.70205","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:46:51Z","timestamp":1784180811000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["New\u2010Onset Diabetes and Pancreatic Ductal Adenocarcinoma: Implications for Early Recognition and Clinical Management"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3369-9749","authenticated-orcid":false,"given":"Kun","family":"Huang","sequence":"first","affiliation":[{"name":"Department of General Surgery Mianyang Hospital of Traditional Chinese Medicine  Mianyang Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenghong","family":"Huang","sequence":"additional","affiliation":[{"name":"Medical Insurance Department Youxian 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