SGLT2 inhibitors in T2DM are associated with reduced gastrointestinal cancer risk

Vancouver, Canada — The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors is associated with a reduced risk of gastrointestinal (GI) cancer in patients with: type 2 diabetes New evidence emerges in comparison with dipeptidyl peptidase IV (DPP4) inhibitors.

SGLT2 inhibitors were found to be better than DPP4 inhibitors in reducing the risk of colorectal, liver, esophageal, and other gastrointestinal cancers. pancreatic cancersaid study researcher Shu-Yen Emily Chan, M.D., a gastroenterologist in the Department of Medicine and Epidemiology at Chicago’s Wyeth Memorial Hospital.

Based on this result, doctors can consider SGLT2. canagliflozin, dapagliflozinand empagliflozin In an interview here at the American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting, Chan said GLP-1 should be administered as first-line therapy, especially for T2D patients who are at high risk for gastrointestinal cancers. He said there is.

Previous research has focused on the potential cardiovascular and renal benefits associated with SGLT2, but “few studies have looked at gastrointestinal cancer risk and these drugs,” he said. added. Most of the early research on cancer was preclinical and observational studies. colorectal cancer or hepatocellular carcinoma.

Chan and colleagues used the TriNetX database of millions of medical claims from 92 hospitals across the United States to identify 706,390 adults who started first-line SGLT2 inhibitor therapy. They used propensity matching to identify these patients with DDP4 inhibitors (sitagliptin; Saxagliptin, Linagliptinor alogliptin).

All participants had been diagnosed with type 2 diabetes. Patients were prescribed at least three SGLT2 inhibitors and a cancer diagnosis occurring within at least 6 months of treatment initiation was recorded. Those with a history of cancer, cancer recurrence, or metastatic disease were excluded from the population-based cohort study.

In addition to evaluating a large number of patients, this study is notable for including people with the following symptoms: ulcerative colitis and crohn’s disease It can also be used to evaluate all gastrointestinal cancers, including malignant tumors of the esophagus, stomach, small intestine, colorectal, rectum, anus, liver, bile duct, and gallbladder.

Main findings

Adults who received SGLT2 inhibitors had a 15% overall reduced risk of developing gastrointestinal cancer compared to adults who received DPP4 inhibitors (hazard ratio) [HR]0.85; 95% CI, 0.82 – 0.88).

colon cancer It was the most common malignancy in the study. Chan et al. identified colon cancer in 1,789 people, or 0.25%, of those taking SGLT2 inhibitors, compared to 3,283 (0.46%) of those taking DPP4 inhibitors. Ta.

SGLT2 inhibitors were associated with a 16% reduction in the risk of: stomach cancer (HR, 0.84; 95% CI; 0.74 – 0.945; P = .005), 13% reduction in liver and intrahepatic risk. bile duct cancer (HR, 0.87; 95% CI, 0.81 – 0.95) and a 22% reduction in colon cancer risk (HR, 0.781; 95% CI, 0.74 – 0.83; P < .001) compared to DPP4 drugs.

The only cancer that was more likely to occur in the SGLT2 inhibitor group than in the DPP4 inhibitor group was pancreatic cancer (HR, 1.035; 95% CI, 0.964 – 1.111; P = .340).

The SLGT2 inhibitor class also performed well. metformin Reduces the risk of gastrointestinal cancer.

Asked whether the study results should change current practices, Chan said the study is new and has not yet been published. “Further research is needed and likely to be incorporated into official guidelines before the findings can change practice,” she said.

Limitations of this study include residual confounding, lack of family history of cancer, and information bias. Strengths include a large national database and propensity score matching.

“Eye-opening” research

“This is good research and an eye-opener because it shows that one class of diabetes drugs is better than another class of drugs,” said Professor of Medicine, who co-facilitated the session. said Kenneth J. Vega, MD, chief of the Department of Gastroenterology. Augusta University – Medical College of Georgia Hepatology.

Vega shared a theory about why diabetes drugs can reduce the risk of gastrointestinal cancer. “I think that reducing diabetes means you can control inflammation…and better control of inflammation leads to less cancer.”

“I think further long-term research is needed,” he added.

This research was supported independently. Mr. Chan and Mr. Vega have not reported any relevant financial relationship.

American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting: Abstract 51. Presented October 24, 2023.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of specialties including infectious diseases, gastroenterology, and emergency medicine. Follow Damian on Twitter: @MedReporter.For more news, follow Medscape Facebook,X (old Twitter), Instagramand YouTube.