ASPO Abstracts
Anti-diabetic medication use and survival among cancer patients with type 2 diabetes: A prospective study using electronic medical records data
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2023
Abstract Body:
Conflicting evidence exists on the association of established anti-diabetic drugs with survival in cancer patients; association of newer anti-diabetic agents with survival is unknown. We utilized data on 2,675 patients diagnosed with primary cancer at the Huntsman Cancer Institute, Utah, who also had a type-2 diabetes diagnosis. Clinicodemographic and cancer treatment data were extracted from electronic medical records and tumor registry between July '16 – January '21. Associations of metformin, sulfonylureas, thiazolidinediones, insulin, SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 agonists with overall survival were evaluated using Kaplan-Meier (KM) curves and Cox proportional hazards models. On average, patients were 63 years old, female, 88% White, 9% Hispanic, with mean BMI 33 kg/m2, and consisted of gastrointestinal (20%), breast (15%), lung (15%), urogenital (40%), and skin (10%) cancers. Most (91%) received anti-diabetic agents, including metformin (29%), insulin (26%), sulfonylureas (13%), DPP-4 inhibitors (9%), GLP-1 agonists (8%), SGLT-2 inhibitors (6%), and thiazolidinediones (3%). Median survival time for ever vs. never use of GLP-1 agonists and SGLT-2 inhibitors was significantly longer (3.7 vs. 1.6 years and 4.2 vs. 1.6 years, respectively; p<0.05). Metformin ever use was associated with statistically significant better overall survival [HR (95% CI) =0.59(0.45-0.77)] after adjusting for age, sex, race/ethnicity, smoking, BMI, cancer type, cancer treatment, corticosteroid use, and mutually adjusting for other anti-diabetic drug use. Ever use of DPP-4 inhibitors, GLP-1 agonists, and SGLT-2 inhibitors was also associated with better overall survival, though not statistically significant. Ever use of insulin and thiazolidinediones was associated with significantly worse overall survival [adjusted HR (95% CI) =1.35(1.05-1.22) and 2.86(1.47-5.56), respectively]. In conclusion, metformin use was associated with better overall survival in cancer patients. There was a suggestive association of better overall survival with newer anti-diabetic agents, however, it did not reach statistical significance due to limited sample sizes. Further investigation in larger studies is needed to establish the role of newer anti-diabetic agents in cancer survival.
Keywords: Cancer, diabetes type 2, anti-diabetic drugs, survival