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The following is a summary of “Hematologic Cancers Among Patients With Type 2 Diabetes Prescribed GLP-1 Receptor Agonists,” published in the March 2025 issue of JAMA Network Open by Ashruf et al. 

Type 2 diabetes (T2D) and obesity increase the risk of hematologic cancers. The impact of Glucagon-like peptide–1 receptor agonists (GLP-1RA) on these cancers remains unclear. 

Researchers conducted a retrospective study comparing hematologic cancer risk in patients with T2D treated with GLP-1RAs, metformin, or insulin.  

They conducted a retrospective cohort study using TriNetX, analyzing electronic health records from one-quarter of the US population. Patients with T2D prescribed GLP-1RA, insulin, or metformin between April 30, 2005, and October 31, 2023, were identified, excluding those with prior hematologic cancers or antidiabetic prescriptions before diagnosis. About 2 comparisons were performed: GLP-1RA vs. metformin and GLP-1RA vs. insulin. Propensity score matching (1:1) was applied for demographics, BMI, diabetic complications, HbA1C, genetic susceptibility, cancer screenings, and other factors. HRs with 95% CIs and cumulative incidences were estimated using Cox proportional hazard and Kaplan-Meier analyses, with significance set at P < .05. 

The results showed 1,601,334 patients (mean [SD] age, 62.5 [14.4] years; 751,026 females [46.9%]) with T2D, including 51,617 on GLP-1RA, 611,115 on metformin, and 938,602 on insulin. The mean (SD) GLP-1RA duration was 485.4 (139.0) days. After matching, 47,716 were in the GLP-1RA–insulin analysis and 50,590 in the GLP-1RA–metformin analysis. Compared with metformin, GLP-1RA use lowered myelodysplastic syndromes (MDSs) risk (HR, 0.61; 95% CI, 0.42-0.89) and myeloproliferative neoplasms (MPNs) risk (HR, 0.67; 95% CI, 0.52-0.87) with no difference in other cancers. Compared with insulin, GLP-1RA use reduced risk of myeloid leukemia (HR, 0.39; 95% CI, 0.25-0.60), lymphoid leukemia (HR, 0.45; 95% CI, 0.30-0.68), non-Hodgkin lymphoma (HR, 0.42; 95% CI, 0.30-0.58), MDS (HR, 0.19; 95% CI, 0.11-0.35), MPN (HR, 0.50; 95% CI, 0.41-0.61), monoclonal gammopathy (HR, 0.68; 95% CI, 0.52-0.88), multiple myeloma (HR, 0.49; 95% CI, 0.31-0.76), and amyloidosis (HR, 0.52; 95% CI, 0.27-0.98). Overall, GLP-1RA use lowered hematologic cancer risk by 54% compared with insulin. 

Investigators found that GLP-1RAs were associated with a lower risk of several hematologic cancers, particularly MDS and MPN, in patients with T2D. This reduction may be linked to weight loss, immunomodulation, or both, independent of glycemic control. 

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2831083