Glucagon-like peptide-1 injectable medication uptake among United States cancer survivors with diabetes: National estimates and socioeconomic patterns from 2024.

Abstract

e23094 Background: Use of glucagon-like peptide-1 (GLP-1) receptor agonists has expanded rapidly for diabetes and obesity management, but real-world uptake among cancer survivors, who often have high cardiometabolic risk, remains poorly characterized. We evaluated national prevalence and correlates of GLP-1 injectable medication use among United States (U.S.) cancer survivors with diabetes. Methods: We conducted a cross-sectional analysis of the 2024 National Health Interview Survey (NHIS) adult sample using IPUMS NHIS. Cancer survivorship was defined as a self-reported history of cancer. The primary cohort included adult cancer survivors with diabetes; a secondary cohort included survivors with diabetes or prediabetes. The outcome was self-reported use of GLP-1 injectable medication. We estimated survey-weighted prevalence overall and by insurance, poverty level (Federal Poverty Level [FPL] categories), and obesity status (Body mass index [BMI] ≥30 vs < 30). Adjusted prevalence ratios (aPR) were estimated using survey-weighted Poisson regression with log link, adjusting for insurance, poverty, obesity, age, sex, race/ethnicity, education, insulin use, diabetes pill use, and diabetes duration. Results: The primary cohort included 692 cancer survivors with diabetes (unweighted; GLP-1 users n = 148). The weighted prevalence of GLP-1 injectable use was 21.2% (95% confidence interval [CI] 17.3–25.0). Uptake varied by insurance (Private 25.5%, Medicare 17.6%, Medicaid 36.3%, Uninsured 28.9%, Other 11.0%) and poverty ( < 100% FPL 16.8% vs ≥400% FPL 25.0%). GLP-1 use was higher among survivors with obesity (BMI ≥30, 27.6% vs BMI < 30, 16.2%). In adjusted models, obesity (BMI ≥30) was independently associated with greater GLP-1 use (aPR 1.65, 95% CI 1.16–2.33, p = 0.005), as was higher income (≥400% FPL vs < 100% FPL: aPR 2.09, 95% CI 1.09–3.98, p = 0.026). In the secondary cohort of survivors with diabetes or prediabetes (n = 1273), weighted GLP-1 injectable use was 14.1% (95% CI 11.7–16.5). Conclusions: Approximately 1 in 5 U.S. cancer survivors with diabetes reported GLP-1 injectable use in 2024. Uptake was higher among survivors with obesity and higher socioeconomic status, suggesting potential access or prescribing disparities in this high-risk population. Future work should evaluate longitudinal patterns and cancer-type–specific differences as newer agents diffuse into routine survivorship care.