Award: ACG Outstanding Research Award in the Biliary/Pancreas Category (Trainee)
Khaled Alsabbagh Alchirazi, MD1, Ahmed El Telbany, MD, MPH2, Michelle Baliss, DO3, Muaz Alsabbagh, MD4, Wissam Kiwan, MD5, Mohammad Bilal, MD6 1Aurora Healthcare, Brookfield, WI; 2University of New Mexico, Albuquerque, NM; 3SSM Health Saint Louis University Hospital, St. Louis, MO; 4Cleveland Clinic, Cleveland, OH; 5Saint Louis University, St. Louis, MO; 6University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN
Introduction: Type 2 diabetes (T2D) is a well-established risk factor for several malignancies, including pancreatic cancer. This association has prompted investigations into the potential impact of diabetes medications on cancer risk. Among these medications, GLP-1 receptor agonists (GLP-1RAs) have gained attention due to their unique mechanism of action. Our study seeks to explore the relationship between GLP-1RAs therapy in T2D patients and the incidence of pancreatic cancer, comparing it with the incidence observed in patients treated with other antidiabetic therapies.
Methods: We accessed deidentified electronic health records from the TriNetX database, to identify patients with T2D who had medical encounters for T2D and were subsequently prescribed antidiabetic medications from 2005 to 2020, no prior antidiabetic drugs use (drug naive), and no prior Pancreatic cancer (PC) diagnosis. Our study compared GLP-1RAs with other antidiabetics medications: insulin, metformin, alpha-glucosidase inhibitors, dipeptidyl-peptidase 4 (DPP-4) inhibitors (from 2006), sodium-glucose cotransporter-2 (SGLT2) inhibitors (from 2013), sulfonylureas, and thiazolidinediones. Patients were propensity score matched (PSM) (1:1) for demographics, health determinants, medical history, acute and chronic pancreatitis, family history of cancers and lifestyle factors. We evaluated the risk of PC over 15 years using Kaplan-Meier analysis with hazard ratios (HRs) and 95% confidence intervals (CIs), stratifying by obesity status, with a significance threshold of P < 0.05.
Results: We identified a total of 4,950,000 patients with history of T2D, among them 245,532 patients on GLP1-RAs. We found that T2D patients on GLP-1RAs showed a significantly lower risk of developing PC compared to those treated with insulin (HR, 0.56; 95% CI, 0.44-0.72), DPP-4 inhibitors (HR 0.80; 0.73-0.89), SGLT2 inhibitors (HR 0.78; 0.69-0.89), and sulfonylureas (HR 0.84; 0.74-0.95). Consistent findings were observed in patients with obesity/overweight on GLP-1RAs when compared with insulin (HR 0.53; 0.43-0.65) and SGLT2 inhibitors (HR 0.81; 0.69-0.96).
Discussion: Our study demonstrates that patients with T2D, both obese and non-obese, who are treated with GLP-1RAs, exhibit a significantly reduced risk of pancreatic cancer compared to those receiving other antidiabetic treatments. These findings suggest a potentially important role for GLP-1RAs medications in cancer prevention. Further research is needed to explore the underlying mechanisms of these effects.
Table: Table 1: Risks and Hazard Ratios (HRs) of First-Time Diagnosis of Pancreatic Cancer (PC) in Drug-Naive Patients With Type 2 Diabetes (Top) and in Drug-Naive Obese patients with Type 2 Diabetes after propensity score matching:
Disclosures:
Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.
Ahmed El Telbany indicated no relevant financial relationships.
Michelle Baliss indicated no relevant financial relationships.
Muaz Alsabbagh indicated no relevant financial relationships.
Wissam Kiwan indicated no relevant financial relationships.
Mohammad Bilal: Boston Scientific – Consultant. Cook endoscopy – Speakers Bureau.
Khaled Alsabbagh Alchirazi, MD1, Ahmed El Telbany, MD, MPH2, Michelle Baliss, DO3, Muaz Alsabbagh, MD4, Wissam Kiwan, MD5, Mohammad Bilal, MD6, 52, GLP-1 Receptor Agonists and Pancreatic Cancer Risk in Drug-Naive Patients With Type 2 Diabetes, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
