Safety and Efficacy of SGLT2 Inhibitors in Patients With Cancer and Diabetes

The cohort was split into two groups: 169 individuals who received a sodium glucose cotransporter-2 inhibitor (SGLT2i) before cancer diagnosis, and 680 individuals who were naïve to SGLT2i therapy.

• This report describes a retrospective, single-center analysis enrolling 849 adults with diabetes and active cancer.

• The investigation aimed to characterize safety and efficacy of SGLT2 inhibitors in the specific intersection of diabetes and cancer, acknowledging prior data show mortality benefits in the general diabetic population but limited cancer-specific evidence.

• Exposure: prior receipt of an SGLT2 inhibitor before cancer diagnosis.
• Comparator: no prior SGLT2i exposure during the cancer-diabetes co-morbidity course.

• Median follow-up duration was 48 months (interquartile range 27–72 months).
• The primary endpoint was all-cause mortality.
• A secondary composite cardiovascular endpoint encompassed heart failure, acute coronary syndrome, and arrhythmias.

• All-cause mortality favored the SGLT2i-treated group, with 67% mortality in the exposed cohort versus 53% in the unexposed cohort (P=0.001).
• Multivariable Cox modeling identified SGLT2i exposure as an independent predictor of reduced all-cause mortality (hazard ratio 0.676; 95% CI 0.532–0.860; P=0.001).
• Cardiovascular outcomes appeared more frequent in the SGLT2i group (28% vs 16%; P=0.001), driven largely by higher heart failure events (14% vs 7%; P=0.008).
• After propensity score matching, SGLT2i remained associated with reduced mortality (P=0.016), but there were no statistically significant differences in the composite cardiovascular outcome (P=0.067).

• The analysis is retrospective and single-center, which may limit generalizability and introduce residual confounding.
• Despite adjustment and matching, causal inference remains constrained without randomized data.
• The authors explicitly call for randomized clinical trials to confirm findings and to elucidate potential mechanisms.