INS and diabetes mellitus: A history of diabetes is a common clinical risk factor in pancreatic cancer risk prediction models, and studies have shown that people with higher MHR may have more severe diabetes (Song et al., 2023), and poorly controlled diabetes increases the risk of pancreatic cancer in diabetic patients through the cellular proliferative effects of hyperglycemia, hyperinsulinemia, and abnormalities in insulin/IGF receptor pathways (Cui and Andersen Dana, 2012).