Impact of SGLT2 Inhibitors on Tumor Development Risk in Type 2 Diabetes: A Retrospective Cohort Study

Abstract

Aim: To assess the association between sodium-glucose cotransporter 2 (SGLT2) inhibitor use and the risk of tumor development and survival outcomes in patients with type 2 diabetes. Methods: This retrospective cohort study included 350 patients with type 2 diabetes treated at our institution between January 2021 and January 2025. Patients were categorized into an observation group (n = 189) receiving SGLT2 inhibitors and a control group (n = 161) treated with other antidiabetic medications. Clinical characteristics, glycemic control, cumulative drug exposure, and tumor incidence (lung, colorectal, prostate, breast, bladder, and hepatic cancers) were analyzed. Kaplan–Meier methods were used to evaluate cancer incidence and mortality outcomes. Results: Overall tumor incidence was significantly lower in the SGLT2 inhibitor group than in the control group (P < 0.001), mainly due to reduced lung (P = 0.018) and ovarian cancers (P = 0.017). Smoking, alcohol consumption, and poor glycemic control were associated with higher overall and site-specific tumor risks. The SGLT2 inhibitor group showed better metabolic profiles, with lower FBG, HbA1c, LDL, TC, TG, and higher HDL levels (all P < 0.05), as well as improved renal function indicated by lower BUN and creatinine and higher eGFR (all P < 0.001). Kaplan–Meier analysis demonstrated significantly longer progression-free and overall survival in the SGLT2 inhibitor group (both P < 0.01). Conclusion: SGLT2 inhibitors reduced overall tumor risk, especially lung and ovarian cancers, and improved metabolic and survival outcomes in type 2 diabetes.