Elevated levels of insulin and insulin-like growth factors (IGFs), such as IGF-I, are important mechanisms underlying the association between obesity, diabetes, and pancreatic cancer.62 Insulin, IGF-1, and the insulin receptor-related receptor can form functional hybrids.63 IGF1 and IGF1 receptors are highly expressed in pancreatic cancer cells, and IGF2 imprinting is disrupted in many tumors.64 This evidence concerns the gene INSR and obesity due to melanocortin 4 receptor deficiency.