Background: Diagnostic delay contributes to high mortality rates for pancreatic carcinoma. In 50-80% of patients with pancreatic carcinoma diabetes mellitus is present 1-3 years before the carcinoma is diagnosed. Primary care guidelines devote little attention to differentiating characteristics between diabetes mellitus due to pancreatic disease and other types.

Aim: This commentary, accompanying a previously published case-series, reflects on the reciprocal relationship between pancreatic carcinoma and diabetes mellitus. Increasing awareness of atypical signs in diabetes mellitus presentation/course might aid primary care physicians in identifying patients with possible underlying/co-existing pancreatic carcinoma, possible decreasing the diagnostic delay.

Take home message: Atypical course can be understood as the following: a) weight loss preceding the diagnosis ‘diabetes mellitus type 2’ that persists despite (adequate) treatment; b) the lack of accompanying metabolic characteristics such as dyslipidemia, hypertension, or obesity (common soil); and c) (sub-)acute deterioration of glycemic control that cannot be attributed to other factors.