GLP-1 RAs reduced multiple myeloma risk by 36% (HR 0.64, p=0.01) in T2D patients. SGLT2i use was associated with increased mortality in multiple myeloma (HR 2.27) and AML (HR 2.00).
Opposite effects on blood cancerGLP-1 drugs reduce myeloma risk by 36% while SGLT2 inhibitors increase mortality 2.3× in myeloma patients — critical for drug selection
What the researchers found
GLP-1 RA: multiple myeloma risk HR 0.64 (p=0.01), preserved in BMI>30 and HbA1c>8% subgroups. SGLT2i: increased mortality in MM (HR 2.27, p<0.001) and AML (HR 2.00, p=0.006). No significant effects for CML or MDS.
Why it matters
Millions of cancer patients have diabetes. Knowing which diabetes drug increases or decreases cancer risk/mortality directly affects drug selection.
How the study worked
Multicenter retrospective TriNetX cohort (2019-2024), T2D patients comparing GLP-1 RA, SGLT2i, and neither for incidence of 4 hematologic malignancies and associated mortality via Cox regression.
What this study cannot tell us
Retrospective. Cannot prove causation. Hematologic malignancy is rare; small event numbers. SGLT2i mortality finding is novel and needs replication.
How to read the evidence
Large multicenter retrospective study. Novel findings needing prospective confirmation, especially the SGLT2i mortality signal.
When this study was published
Published in 2025.
The bigger picture
Diabetes drugs have divergent effects on cancer biology. GLP-1 drugs may protect against some cancers while SGLT2 inhibitors may worsen outcomes in others — requiring careful drug selection.
Questions still open
- What mechanism explains GLP-1 protection against multiple myeloma?
- Should SGLT2i be avoided in patients with blood cancers?
- Is the SGLT2i mortality increase a direct drug effect or confounding?
Common questions
Do diabetes drugs affect blood cancer risk?
Should cancer patients avoid SGLT2 inhibitors?
Read the original research
Incidence of hematologic malignancies and mortality associated with GLP-1 receptor agonist and SGLT2 inhibitor use in type 2 diabetes mellitus: results of a retrospective cohort study of electronic health records.
EClinicalMedicine, 91, 103749
Citation
Irons, Eric Edward; Pfeil, Keri Ann; Perez, Jaime Abraham; van Besien, Koen. (2026). Incidence of hematologic malignancies and mortality associated with GLP-1 receptor agonist and SGLT2 inhibitor use in type 2 diabetes mellitus: results of a retrospective cohort study of electronic health records.. EClinicalMedicine, 91, 103749. https://doi.org/10.1016/j.eclinm.2025.103749