Examining GLP-1 Trends in T2D, Risk of Obesity-Related Malignancies
Three posters presented at the American Diabetes Association 84th Scientific Sessions looked into the current landscape of GLP-1s.
Glucagon-like peptide-1 receptor agonists (GLP-1s) have gained widespread attention over the last several years. The class of drugs, which includes semaglutide and tirzepatide, are used to treat type 2 diabetes and obesity or overweight. Research has shown that GLP-1s are effective at improving glycemic control, reducing body weight, and lowering the risk of major adverse cardiovascular events.1
Examining GLP-1 Trends in T2D, Risk of Obesity-Related Malignancies / K KStock - stock.aobe.com
At the American Diabetes Association 84th Scientific Sessions, held June 21 to 24 in Orlando, Florida, 3 posters looked into the current landscape of GLP-1s, examining the risk of developing obesity-associated malignancies, trends in use in patients with type 2 diabetes, and utilization trends and uptake of tirzepatide.
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In the first poster, investigators conducted a real-world retrospective cohort study to assess the risk of developing 13 obesity-associated malignancies in patients with type 2 diabetes receiving GLP-1s.2 Data was gathered from electronic health records of 130 million adults from Eversana Life Sciences. The study cohort included 60392 patients with a new type 2 diabetes diagnosis and no history of malignancy who were prescribed GLP-1s or other anti-hyperglycemic agents between 2010 and 2023.
Of the study cohort, 30196 were prescribed GLP-1s within 12 months of their type 2 diabetes diagnosis. These patients were propensity matched to patients on other anti-hyperglycemic agents. Investigators found that there was a total of 1219 malignancies after a mean follow up of 2.9 years. The most common malignancy was breast followed by prostate and colorectal. Although patients taking GLP-1s had a higher risk for prostate cancer, there was no increased rate of other or overall malignancies.
In the second poster, investigators conducted a pooled cross-sectional study to examine trends in GLP-1 use among patients with only type 2 diabetes, only obesity, and type 2 diabetes and obesity.3 Data was gathered from electronic health records from the Epic Cosmos database and the study cohort included 67.9 million individuals.
Investigators found that from 2010 to 2016 there was a gradual increase in GLP-1 use among all 3 groups. However, from 2016 to 2023, there was a pronounced and accelerated uptake. Females in the obesity-only group had 1.47 times faster uptake than males, and post-college education had a 1.76 times faster uptake compared to their counterparts. Among patients under the age of 19, uptake was 0% from 2010 to 2017, but surged to 35.3% in 2023.
“We found an upward trend in GLP-1 utilization since 2016 when FDA approval occurred, though use was disproportionate among some groups, raising concerns about inequitable access,” the authors concluded.
In the third poster, investigators conducted a study to examine the utilization trends and uptake of tirzepatide in adults with type 2 diabetes in the US.4 Data for the study was gathered from a commercial claims database. The study cohort included adults with type 2 diabetes who initiated glucose-lowering drugs between January 2021 and June 2023.
For the study, investigators plotted monthly drug initiation trends before and after the approval of tirzepatide, which occurred in May 2022. The uptake of tirzepatide was also compared to the uptake of other GLP-1s during the first 13 months since their initial approval.
Investigators found GLP-1 use increased from 17.6% to 23% and sodium-glucose cotransporter-2 (SGLT2) inhibitor use increased from 15.6% to 20% during the study period. The data also showed that metformin use decreased from 25.5% to 20.7%. After October 2022, tirzepatide use increased significantly to 11.5% in June 2023. By the end of the study period, GLP-1s were the most frequently initiated glucose-lowering drugs.
“The uptake of tirzepatide is unprecedented with respect to any other GLP-1,” the authors concluded.
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References
1. Hu EH, Tsai ML, Lin Y, et al. A Review and Meta-Analysis of the Safety and Efficacy of Using Glucagon-like Peptide-1 Receptor Agonists. Medicina (Kaunas). 2024 Feb 21;60(3):357. doi: 10.3390/medicina60030357. PMID: 38541083; PMCID: PMC10972401.
2. Ishola FA, Pike CW, Kim SH.GLP-1 RA and Risk of Malignancy in Patients with Type 2 Diabetes. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 746-P.
3. Li P, Varghese JM, Shah MK, et al. Trends in GLP-1RA Use among Individuals with Type 2 Diabetes (T2D) and/or Obesity—Insights from a Nationwide Electronic Health Record System, 2010–2023. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 850-P.
4. Patorno E, Tesfaye H, Ortega-Montiel J,et al. Changing Trends in Glucose-Lowering Drug Initiation for Type 2 Diabetes in the Era of Tirzepatide. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 1409-P.
