Adults with diabetes and a history of cancer were less likely to report current use of injectable glucagon-like peptide-1 receptor agonists (GLP-1 RAs) than those without a cancer history, despite having higher rates of cardiovascular and kidney disease. Olinto Linares-Perdomo, PhD, and colleagues reported the findings in JAMA Network Open.
GLP-1 RAs can improve glycemic control, promote weight loss, and reduce cardiovascular and kidney risk in adults with type 2 diabetes. Cancer survivors may particularly benefit from those effects because cancer and its treatment can increase cardiovascular, metabolic, and kidney risks, the investigators noted.
Study Details
The cross-sectional study used data from the 2024 National Health Interview Survey. Investigators identified 3,615 adults with diagnosed diabetes, representing an estimated 26.4 million U.S. adults. Of these, 674 had a history of cancer and 2,941 did not.
Cancer history was defined as any clinician-diagnosed cancer other than nonmelanoma skin cancer alone. Current injectable GLP-1 RA use was based on whether participants reported taking a noninsulin injectable medication to lower blood glucose or lose weight.
Cancer survivors were older than participants without a cancer history, with mean ages of 69 vs 61.1 years. They also had higher rates of atherosclerotic cardiovascular disease, at 33.8% vs 23.6%, and chronic kidney disease, at 19.8% vs 10.9%.
The analyses adjusted for demographic, socioeconomic, and clinical factors, including age, sex, race and ethnicity, education, income, insurance, region, body mass index, cardiovascular disease, and chronic kidney disease.
Key Findings
Before adjustment, 20% of adults with a cancer history reported current injectable GLP-1 RA use compared with 27.9% of those without a cancer history.
The difference persisted after adjustment, with estimated GLP-1 RA use of 20.5% among cancer survivors and 26.5% among adults without a cancer history, corresponding to approximately 30% lower odds of GLP-1 RA use among cancer survivors (odds ratio = 0.70).
The gap was also seen among adults with private insurance and among Medicare beneficiaries. Adjusted GLP-1 RA use was 5 percentage points lower among privately insured cancer survivors and 3 percentage points lower among Medicare beneficiaries with a cancer history than among their counterparts without cancer.
When the analysis was limited to adults with type 2 diabetes, GLP-1 RA use was still lower among those with a cancer history, but the difference was no longer statistically significant. The adjusted odds ratio was 0.80, with a 4.1–percentage-point difference.
The investigators emphasized that the study cannot determine why GLP-1 RA use was lower among cancer survivors or whether the observed differences represent undertreatment.
“The available data do not identify its causes or indicate whether treatment was clinically appropriate,” they wrote.
The study was limited by its cross-sectional design and reliance on self-reported cancer history, diabetes, and medication use. Oral GLP-1 RAs were not captured, and the survey lacked detailed information on cancer and diabetes characteristics, contraindications, formulary coverage, clinical eligibility, and use of sodium-glucose cotransporter 2 inhibitors.
The authors said further studies are needed to determine whether the differences reflect eligibility, prescribing practices, patient preferences, treatment priorities, or health-system factors.
Bismarck C. Odei, MD, of Huntsman Cancer Institute at the University of Utah Health, is the corresponding author.
DISCLOSURE: The study was supported by University of Utah Health. For full disclosures of the study authors, visit jamanetwork.com.
