Primary care referrals and abdominal imaging in people with new-onset diabetes and weight loss: cohort study using the English national sentinel network database
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objectives Pancreatic cancer is diagnosed in approximately 1% of individuals with new-onset diabetes, increasing to 3% among those aged ≥60 years with weight loss. UK clinical guidelines recommend abdominal imaging to rule out pancreatic cancer in this high-risk group. In June 2025, National Health Service (NHS) England launched a case-finding pilot to test approaches to improve primary care referrals for imaging in these patients and improve the quality of body weight and diabetes-related data recorded in electronic healthcare records (EHRs). This study reports referral and imaging rates among the eligible group and the availability of body weight and glycated haemoglobin (HbA1c) measurements in people with diabetes, providing baseline data prior to implementation of the NHS England pilot.
Design Retrospective cohort study.
Setting Primary care. The database of 8 million patients from 781 general practices from the Royal College of General Practitioners Research and Surveillance Centre.
Participants Adults diagnosed with diabetes between 2015 and 2021.
Outcome measures Proportions of eligible individuals who received a referral and imaging within 12 months before or after diabetes diagnosis and the number of body weight and HbA1c measurements recorded for individuals with diabetes.
Results Among 180 815 individuals diagnosed with diabetes, 92 210 (51.0%) were aged ≥60 years (median age 71, 46% women). Overall, 152 300 (84.2%) had at least one body weight and 161 631 (89.4%) had at least one HbA1c measurement recorded in EHRs. Among the 1411 patients with new-onset diabetes and weight loss, 372 (26.4%) had a referral, 141 (10.0%) imaging and 40 (2.8%) had pancreatic cancer recorded.
Conclusions This study demonstrated potential underutilisation of referral guidance and under-referral among the eligible population. The findings provide baseline data to support the launch of the NHS England pilot. Further research is needed to better understand current practice and support the implementation of cancer referral guidelines.
Data availability statement
Data may be obtained from a third party and are not publicly available. No data were generated by this research. Data used in this study are available from theOxford Clinical Informatics Digital Hub (ORCHID). Access requires approval by the Primary Care Hosted Research Datasets Independent Scientific Committee (PrimDISC). Information on the application process is available at https://orchid.phc.ox.ac.uk/orchid_epidemiology.
Design Retrospective cohort study.
Setting Primary care. The database of 8 million patients from 781 general practices from the Royal College of General Practitioners Research and Surveillance Centre.
Participants Adults diagnosed with diabetes between 2015 and 2021.
Outcome measures Proportions of eligible individuals who received a referral and imaging within 12 months before or after diabetes diagnosis and the number of body weight and HbA1c measurements recorded for individuals with diabetes.
Results Among 180 815 individuals diagnosed with diabetes, 92 210 (51.0%) were aged ≥60 years (median age 71, 46% women). Overall, 152 300 (84.2%) had at least one body weight and 161 631 (89.4%) had at least one HbA1c measurement recorded in EHRs. Among the 1411 patients with new-onset diabetes and weight loss, 372 (26.4%) had a referral, 141 (10.0%) imaging and 40 (2.8%) had pancreatic cancer recorded.
Conclusions This study demonstrated potential underutilisation of referral guidance and under-referral among the eligible population. The findings provide baseline data to support the launch of the NHS England pilot. Further research is needed to better understand current practice and support the implementation of cancer referral guidelines.
Data availability statement
Data may be obtained from a third party and are not publicly available. No data were generated by this research. Data used in this study are available from theOxford Clinical Informatics Digital Hub (ORCHID). Access requires approval by the Primary Care Hosted Research Datasets Independent Scientific Committee (PrimDISC). Information on the application process is available at https://orchid.phc.ox.ac.uk/orchid_epidemiology.
Date Issued
2026-08-01
Date Acceptance
2026-08-06
Citation
BMJ Open, 2026, 16 (8)
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
16
Issue
8
Copyright Statement
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1136/bmjopen-2026-119662
Publication Status
Published
Article Number
e119662
Date Publish Online
2026-08-18