SGLT2 Inhibitors Show 15% Lower Kidney and Bladder Cancer Risk Than GLP-1 Drugs | Research

The takeaway

In 589,328 matched T2D patients, SGLT2i use was associated with 15% lower renal cell carcinoma (HR 0.85) and 15% lower urothelial cancer risk (HR 0.85) compared to GLP-1 RA use over 44 months.

15% lower cancer rate
SGLT2 inhibitors showed modestly lower kidney and bladder cancer rates than GLP-1 drugs in nearly 600,000 matched diabetic patients

What the researchers found

SGLT2i vs GLP-1 RA (294,664 per cohort): RCC HR 0.85 (0.79-0.92); UCC HR 0.85 (0.78-0.92); mean follow-up 44.2 months; consistent across demographic and comorbidity subgroups.

Why it matters

Cancer is a common concern for patients on long-term metabolic drugs. Comparative cancer safety data helps inform drug selection.

How the study worked

New-user comparative cohort with target trial emulation framework using TriNetX (2014-2024), 1:1 propensity matching on extensive covariates, Kaplan-Meier and Cox regression for incident RCC and UCC.

What this study cannot tell us

Observational. Cannot prove causation. Urological cancers develop over decades; 44-month follow-up may be too short. GLP-1 RA is the comparator, not placebo.

How to read the evidence

Very large propensity-matched cohort with target trial emulation. Consistent subgroup analyses strengthen the finding.

When this study was published

Published in 2025.

The bigger picture

This comparison of two widely used drug classes provides reassurance about cancer safety while suggesting SGLT2 inhibitors may have modest urological cancer-protective properties.

Questions still open

Do SGLT2 inhibitors directly protect against kidney/bladder cancer?
Is the 15% difference clinically significant given long cancer latency?
Should cancer risk factor into SGLT2i vs GLP-1 RA selection?

Common questions

Do diabetes drugs affect cancer risk?

Both SGLT2 inhibitors and GLP-1 drugs appear cancer-safe, but this study found SGLT2 inhibitors had slightly lower rates of kidney and bladder cancer — a modest but consistent difference.

Should cancer risk affect my diabetes drug choice?

For most patients, the small cancer risk difference should not be the primary factor. However, patients with strong urological cancer risk factors might consider this data when choosing between drug classes.

Read the original research

Renal and urothelial cancer risks with SGLT2 inhibitors vs GLP-1 receptor agonists in type 2 diabetes: a target trial emulation.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

View on PubMed ↗Publisher’s paper ↗

Citation

Huang, Chien-Wei; Lai, Edward Chia-Cheng; Wu, Vin-Cent; Hsieh, Miyuki Hsing-Chun; Li, Chia-Jung; Chang, Renin; Chen, Jin-Shuen; Tsai, Yau-Sheng; Sung, Junne-Ming. (2026). Renal and urothelial cancer risks with SGLT2 inhibitors vs GLP-1 receptor agonists in type 2 diabetes: a target trial emulation.. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. https://doi.org/10.1093/ndt/gfag028