To assess whether current injectable GLP-1 receptor agonist (GLP-1 RA) use differed by cancer history among US adults with diabetes.
Approach:
Design and population: Cross-sectional analysis of 2024 National Health Interview Survey data. The analytic cohort included 3,615 adults with diagnosed diabetes; 674 reported a cancer history, excluding nonmelanoma skin cancer alone.
Analysis: Survey-weighted logistic regression estimated adjusted GLP-1 RA use, accounting for demographic, socioeconomic, and clinical factors. A prespecified sensitivity analysis was restricted to adults with type 2 diabetes.
Key Findings:
Adjusted injectable GLP-1 RA use was 20.5% (95% CI, 20.1%-20.9%) among cancer survivors and 26.5% (95% CI, 26.1%-27.0%) among adults without cancer history: a difference of −6.0 percentage points (95% CI, −6.6 to −5.4) and adjusted odds ratio of 0.70 (95% CI, …
Cancer survivors had higher prevalences of atherosclerotic cardiovascular disease and chronic kidney disease than adults without cancer history.
In the type 2 diabetes sensitivity analysis, the association was directionally similar but not statistically significant (adjusted odds ratio, 0.80; 95% CI, 0.58-1.10).
Insurance type modified the association (P for interaction = .045). Adjusted differences were −5.0 percentage points among privately insured adults and −3.0 percentage points among Medicare beneficiaries.
Interpretation:
In this nationally representative cross-sectional study, adults with diabetes and a cancer history had lower adjusted odds of current injectable GLP-1 RA use. The study could not establish why use differed or whether treatment was clinically appropriate.
Limitations:
Cross-sectional design does not establish causality.
Diabetes, cancer history, and medication use were self-reported.
The medication question assessed injectable noninsulin drugs; oral GLP-1 RA exposure was not captured.
The type 2 diabetes sensitivity analysis was less precise and not statistically significant.
Conclusion:
The authors state that longitudinal research with more comprehensive clinical data is needed to determine whether differences relate to eligibility, prescribing, patient preferences, treatment priorities, or health-system factors.
Harold Burstein, MD, PhD, and Jennifer A. Ligibel, MD discuss new research from the Breast Cancer Weight Loss (BWEL) trial, as well as recommendations for lifestyle, diet and GLP1 agonists.
