Cancer
Sodium-glucose cotransporter 2 inhibitors and prostate cancer among type 2 diabetes patients: observational evidence from All of US Yangbo Sun* Yangbo Sun Qian Yang Jay H. Fowke Feng Liu-Smith Jie Zheng
Sodium-glucose cotransporter 2 inhibitors and prostate cancer among type 2 diabetes patients: observational evidence from All of US
Qian Yang, Jay H. Fowke, Feng Liu-Smith, Jie Zheng, Yangbo Sun
Background
A large randomized controlled trial of sodium-glucose cotransporter 2 inhibitor (SGLT2-i) provided suggestive but inconclusive evidence on reducing prostate cancer (PCa) risk. A more recent study triangulated Mendelian randomization analyses in Europeans against electronic health records (EHR) data from Shanghai, China, and also suggested a potential protective association. Our goal is to clarify whether glucose control via SGLT2-I among type 2 diabetes (T2D) patients may reduce PCa risk.
Methods
The All of Us study is a large-scale, longitudinal precision medicine initiative aiming to link EHR data from 453,000 participants across the U.S. We conducted real-world data analyses to estimate the association between SGLT2-i and PCa incidence among T2D patients. Our controls used dipeptidyl peptidase-4 inhibitors (DPP4-i) to control glucose. Analyses included 4,059 men without PCa at baseline and who have initiated either SGLT2-i or DPP4- i. Logistic regression was used to estimate the association between SGLT2-i and PCa risk.
Results
Among 2,225 SGLT2-i users, 1.7 % (n=38) developed PCa. Among 1,834 DPP4-i users, 3.7 % (n=67) developed PCa. After adjusting for age, race/ethnicity, education, income levels, smoking status, alcohol use, self-reported health status, and BMI, SGLT2-i use was significantly associated with a lower risk of PCa (OR 0.50, 95% CI: 0.33 to 0.76) compared to diabetic men taking DPP4-i.
Conclusion
Consistent with prior suggestive analyses, our study found that T2D patients taking SGLT2-i had a lower risk of PCa compared to DPP4-1 users. The differences in T2D treatments on PCa pathophysiology remain uninvestigated. Further studies are warranted to validate our findings.