New-onset diabetes significantly raises pancreatic cancer risk, an insight that could transform early detection strategies.

• New-onset diabetes triples pancreatic cancer risk, compared to the general population.
• Recent prediction models achieve AUCs up to 0.91, but face challenges with validation.

Optimizing screening could improve early detection, particularly if localized stage cases are prioritized.

• Current detection rates are too low to be cost-effective, indicating a need for better strategies.