Primary care referrals and abdominal imaging in people with new-onset diabetes and weight loss: cohort study using the English national sentinel network database.

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.