Pre-Diagnosis GLP-1 Receptor Agonist Use and Post-Cancer Mortality in Adults With Obesity and Type 2 Diabetes

Chung Shan Medical University

Status: Completed

Conditions: Neoplasms; Obesity & Overweight; Diabetes Mellitus Type 2

Study type: Observational

Funder types: Other

Identifiers

NCT07513259

CS2-24004

Details and patient eligibility

About

This study will examine whether the type of diabetes treatment used before cancer diagnosis is associated with survival and serious complications after obesity-associated cancer in adults with obesity and type 2 diabetes. The study focuses on glucagon-like peptide-1 receptor agonists (GLP-1 RA) and compares them with other commonly used glucose-lowering therapies, including SGLT2 inhibitors, DPP-4 inhibitors, sulfonylureas, metformin, and usual care. Using de-identified electronic health record data from the TriNetX US Collaborative Network, the study will assess whether patients who used GLP-1 RA before cancer diagnosis have different risks of death, hospitalization, sepsis, and other major outcomes after cancer diagnosis. This is an observational study designed to evaluate associations in routine clinical care and not to prove a treatment effect.

Enrollment: 203,424 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults aged 18 years or older
• BMI ≥27 kg/m2, or diagnosis codes consistent with obesity
• Type 2 diabetes mellitus
• Initiation of a glucose-lowering medication before obesity-associated cancer diagnosis
• Incident obesity-associated cancer diagnosed after medication initiation
• No dispensing of the study drug class during the 6-month washout period before the first qualifying prescription

Exclusion criteria

• Type 1 diabetes mellitus, Other specified diabetes types that are not type 2 diabetes
• Human immunodeficiency virus infection
• End-stage renal disease
• Prior bariatric surgery
• Prior organ transplantation
• Transplant-related complications
• Any use of tirzepatide before cohort entry

Trial design

203,424 participants in 10 patient groups

GLP-1 RA Without History of SGLT2i

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating a GLP-1 receptor agonist and had no SGLT2 inhibitor prescriptions during the comparator-specific restriction period.

SGLT2i

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating an SGLT2 inhibitor and had no GLP-1 receptor agonist prescriptions during the comparator-specific restriction period.

GLP-1 RA Without History of DPP-4i

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating a GLP-1 receptor agonist and had no DPP-4 inhibitor prescriptions during the comparator-specific restriction period.

DPP-4i

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating a DPP-4 inhibitor and had no GLP-1 receptor agonist prescriptions during the comparator-specific restriction period.

GLP-1 RA Without History of Sulfonylureas

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating a GLP-1 receptor agonist and had no sulfonylurea prescriptions during the comparator-specific restriction period.

Sulfonylureas

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating a sulfonylurea and had no GLP-1 receptor agonist prescriptions during the comparator-specific restriction period.

GLP-1 RA Without History of Metformin

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating a GLP-1 receptor agonist and had no metformin prescriptions during the comparator-specific restriction period.

Metformin

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating metformin and had no GLP-1 receptor agonist prescriptions during the comparator-specific restriction period.

GLP-1 RA

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer after initiating a GLP-1 receptor agonist before cancer diagnosis.

Usual Care

Description:

Adults with obesity and type 2 diabetes who developed an obesity-associated cancer and had no GLP-1 receptor agonist prescriptions before cancer diagnosis; other non-GLP-1 RA diabetes management was permitted.