GLP-1 Receptor Agonist Use and Obesity-Related Cancer Risk Across Levels of Diabetes Severity

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This cohort study emulated 5 active-comparator trials using electronic health records for adults with type 2 diabetes and no prior obesity-related cancer.
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At 3 years, GLP-1 RA initiation was associated with lower obesity-related cancer risk than insulin and sulfonylureas, but not consistently than metformin, SGLT2 inhibitors, or DPP4 inhibitors.
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At 5 years, GLP-1 RA initiation was associated with lower risk than insulin and sulfonylureas; the risk difference versus insulin was −1.67%.
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Associations were clearest among adults with lower-severity diabetes, while the 3-year risk difference in high-severity diabetes favored SGLT2 inhibitors.
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The observational, single-system study was limited by residual confounding, possible exposure and outcome misclassification, and sparse events in some severity strata.

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