A systematic review [54] showed no relationship between using metformin (OR = 0.76, 95% CI: 0.57–1.03), insulin (OR = 1.59, 95% CI: 0.85–2.96), and thiazolidinediones (TZDs) (OR = 1.02, 95% CI: 0.81–1.30), and risk of developing PaCa. This evidence concerns the gene INS and permanent neonatal diabetes mellitus-pancreatic and cerebellar agenesis syndrome.