Diabetes Mellitus Type 2, Neoplasms, Obesity & Overweight
Conditions
Brief summary
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.
Interventions
None listed
Sponsors
Chung Shan Medical University
National Science and Technology Council, Taiwan
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All-cause Mortality (Comparison 1) | From obesity-associated cancer diagnosis through 36 months | All-cause mortality within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 1, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior SGLT2 inhibitor use versus SGLT2 inhibitor-treated adults. |
| All-cause Mortality (Comparison 2) | From obesity-associated cancer diagnosis through 36 months | All-cause mortality within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 2, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior DPP-4 inhibitor use versus DPP-4 inhibitor-treated adults. |
| All-cause Mortality (Comparison 3) | From obesity-associated cancer diagnosis through 36 months | All-cause mortality within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 3, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior sulfonylurea use versus sulfonylurea-treated adults. |
| All-cause Mortality (Comparison 4) | From obesity-associated cancer diagnosis through 36 months | All-cause mortality within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 4, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior metformin use versus metformin-treated adults. |
| All-cause Mortality (Comparison 5) | From obesity-associated cancer diagnosis through 36 months | All-cause mortality within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 5, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist versus adults receiving usual care. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Inpatient (Comparison 1) | From obesity-associated cancer diagnosis through 36 months | Inpatient within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 1, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior SGLT2 inhibitor use versus SGLT2 inhibitor-treated adults. |
| Inpatient (Comparison 2) | From obesity-associated cancer diagnosis through 36 months | Inpatient within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 2, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior DPP-4 inhibitor use versus DPP-4 inhibitor-treated adults. |
| Inpatient (Comparison 3) | From obesity-associated cancer diagnosis through 36 months | Inpatient within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 3, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior sulfonylurea use versus sulfonylurea-treated adults. |
| Inpatient (Comparison 4) | From obesity-associated cancer diagnosis through 36 months | Inpatient within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 4, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior metformin use versus metformin-treated adults. |
| Inpatient (Comparison 5) | From obesity-associated cancer diagnosis through 36 months | Inpatient within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 5, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist versus adults receiving usual care. |
| Pericardial Effusion (Comparison 1) | From obesity-associated cancer diagnosis through 36 months | Pericardial effusion within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 1, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior SGLT2 inhibitor use versus SGLT2 inhibitor-treated adults. |
| Pericardial Effusion (Comparison 2) | From obesity-associated cancer diagnosis through 36 months | Pericardial effusion within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 2, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior DPP-4 inhibitor use versus DPP-4 inhibitor-treated adults. |
| Pericardial Effusion (Comparison 3) | From obesity-associated cancer diagnosis through 36 months | Pericardial effusion within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 3, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior sulfonylurea use versus sulfonylurea-treated adults. |
| Pericardial Effusion (Comparison 4) | From obesity-associated cancer diagnosis through 36 months | Pericardial effusion within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 4, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior metformin use versus metformin-treated adults. |
| Pericardial Effusion (Comparison 5) | From obesity-associated cancer diagnosis through 36 months | Pericardial effusion within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 5, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist versus adults receiving usual care. |
| Pulmonary Embolism (Comparison 1) | From obesity-associated cancer diagnosis through 36 months | Pulmonary embolism within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 1, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior SGLT2 inhibitor use versus SGLT2 inhibitor-treated adults. |
| Pulmonary Embolism (Comparison 2) | From obesity-associated cancer diagnosis through 36 months | Pulmonary embolism within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 2, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior DPP-4 inhibitor use versus DPP-4 inhibitor-treated adults. |
| Pulmonary Embolism (Comparison 3) | From obesity-associated cancer diagnosis through 36 months | Pulmonary embolism within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 3, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior sulfonylurea use versus sulfonylurea-treated adults. |
| Pulmonary Embolism (Comparison 4) | From obesity-associated cancer diagnosis through 36 months | Pulmonary embolism within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 4, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior metformin use versus metformin-treated adults. |
| Pulmonary Embolism (Comparison 5) | From obesity-associated cancer diagnosis through 36 months | Pulmonary embolism within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 5, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist versus adults receiving usual care. |
| Sepsis (Comparison 1) | From obesity-associated cancer diagnosis through 36 months | Sepsis within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 1, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior SGLT2 inhibitor use versus SGLT2 inhibitor-treated adults. |
| Sepsis (Comparison 2) | From obesity-associated cancer diagnosis through 36 months | Sepsis within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 2, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior DPP-4 inhibitor use versus DPP-4 inhibitor-treated adults. |
| Sepsis (Comparison 3) | From obesity-associated cancer diagnosis through 36 months | Sepsis within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 3, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior sulfonylurea use versus sulfonylurea-treated adults. |
| Sepsis (Comparison 4) | From obesity-associated cancer diagnosis through 36 months | Sepsis within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 4, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist without prior metformin use versus metformin-treated adults. |
| Sepsis (Comparison 5) | From obesity-associated cancer diagnosis through 36 months | Sepsis within 36 months after obesity-associated cancer diagnosis in the propensity score-matched cohort for Comparison 5, comparing adults with obesity and type 2 diabetes treated with GLP-1 receptor agonist versus adults receiving usual care. |
Countries
Taiwan
Participant flow
Recruitment details
Participants were retrospectively identified from the TriNetX US Collaborative Network using de-identified electronic health records. Eligible adults with obesity and type 2 diabetes who initiated glucose-lowering therapy between January 1, 2018 and October 31, 2025 and subsequently developed an obesity-associated cancer were included based on prespecified eligibility criteria.
Pre-assignment details
Enrollment and Participant Flow counts reflect the unique participants in the overall study population, classified into two mutually exclusive cohorts according to pre-diagnosis GLP-1 RA use. Participants were counted once in the Participant Flow module. Comparator-specific propensity score-matched cohorts were defined separately for prespecified pairwise outcome analyses and are reported in the relevant Baseline Characteristics and Outcome Measures sections.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Customized <65 years (Comparison 1) | 9265 Participants |
| Age, Customized ≥65 years (Comparison 1) | 15121 Participants |
| Age, Customized <65 years (Comparison 2) | 6556 Participants |
| Age, Customized ≥65 years (Comparison 2) | 15752 Participants |
| Age, Customized <65 years (Comparison 3) | 10341 Participants |
| Age, Customized ≥65 years (Comparison 3) | 17803 Participants |
| Age, Customized <65 years (Comparison 4) | 8197 Participants |
| Age, Customized ≥65 years (Comparison 4) | 11441 Participants |
| Age, Customized <65 years (Comparison 5) | 24151 Participants |
| Age, Customized ≥65 years (Comparison 5) | 28715 Participants |
| Ethnicity (NIH/OMB) Comparison 1 Hispanic or Latino | 2031 Participants |
| Ethnicity (NIH/OMB) Comparison 1 Not Hispanic or Latino | 18496 Participants |
| Ethnicity (NIH/OMB) Comparison 1 Unknown or Not Reported | 3859 Participants |
| Ethnicity (NIH/OMB) Comparison 2 Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 2 Not Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 2 Unknown or Not Reported | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 3 Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 3 Not Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 3 Unknown or Not Reported | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 4 Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 4 Not Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Comparison 4 Unknown or Not Reported | 3735 Participants |
| Ethnicity (NIH/OMB) Comparison 5 Hispanic or Latino | 4511 Participants |
| Ethnicity (NIH/OMB) Comparison 5 Not Hispanic or Latino | 39710 Participants |
| Ethnicity (NIH/OMB) Comparison 5 Unknown or Not Reported | 8645 Participants |
| HbA1c ≥7% HbA1c ≥7% (Comparison 1) | 0 Participants |
| HbA1c ≥7% HbA1c ≥7% (Comparison 2) | 7048 Participants |
| HbA1c ≥7% HbA1c ≥7% (Comparison 3) | 0 Participants |
| HbA1c ≥7% HbA1c ≥7% (Comparison 4) | 0 Participants |
| HbA1c ≥7% HbA1c ≥7% (Comparison 5) | 0 Participants |
| Sex/Gender, Customized Female (Comparison 1) | 17330 Participants |
| Sex/Gender, Customized Female (Comparison 2) | 0 Participants |
| Sex/Gender, Customized Female (Comparison 3) | 0 Participants |
| Sex/Gender, Customized Female (Comparison 4) | 0 Participants |
| Sex/Gender, Customized Female (Comparison 5) | 0 Participants |
| Sex/Gender, Customized Male (Comparison 1) | 7042 Participants |
| Sex/Gender, Customized Male (Comparison 2) | 0 Participants |
| Sex/Gender, Customized Male (Comparison 3) | 8444 Participants |
| Sex/Gender, Customized Male (Comparison 4) | 4965 Participants |
| Sex/Gender, Customized Male (Comparison 5) | 7109 Participants |
| Sex/Gender, Customized Unknown or Not Reported (Comparison 1) | 14 Participants |
| Sex/Gender, Customized Unknown or Not Reported (Comparison 2) | 8 Participants |
| Sex/Gender, Customized Unknown or Not Reported (Comparison 3) | 10 Participants |
| Sex/Gender, Customized Unknown or Not Reported (Comparison 4) | 17 Participants |
| Sex/Gender, Customized Unknown or Not Reported (Comparison 5) | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk | EG009 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 876 / 12,060 | 1,233 / 12,125 | 815 / 10,922 | 1,364 / 10,984 | 883 / 13,801 | 1,736 / 13,819 | 631 / 9,590 | 871 / 9,645 | 1,584 / 25,910 | 2,660 / 25,920 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
None listed