Trends and factors associated with glucagon-like peptide 1 receptor agonists prescription for cancer populations with type 2 diabetes.

Abstract

11181 Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in cancer survivors with Type 2 Diabetes (T2D) given its efficacy, yet concerns regarding treatment tolerance, weight loss, and limited oncology-specific guidance during active treatment and survivorship may influence prescribing patterns. To date, little evidence exists regarding the trends and factors associated with GLP-1RA use in cancer populations with T2D. Methods: We conducted a retrospective cohort study using SEER–Medicare data to identify patients newly diagnosed with seven most common cancers in 2010-2021 with pre-existing T2D. Pre-existing T2D was defined by relevant diagnosis codes within 12 months prior to cancer diagnosis. Patients with continuous Medicare Parts A & B and Part D enrollment were followed annually from diagnosis until death or end of follow-up (12/31/2022) to assess GLP-1RA use. A non-cancer cohort with T2D was identified using a 5% random sample of Medicare beneficiaries without cancer. We calculated annual proportions of beneficiaries with any GLP-1RA use, stratified by Traditional Medicare (TM) and Medicare Advantage (MA, data available in 2016-2021). Multivariable logistic regression models evaluated patient sociodemographic and clinical characteristics associated with GLP-1RA use in 2021. Results: We included 482,878 and 542,285 Medicare beneficiaries with T2D in the cancer and non-cancer cohort respectively (1,927,771 and 3,265,774 person-years in 2010-2022). Among TM beneficiaries, GLP-1RA use in the cancer cohort increased from 0.5% to 8.2% in 2010-2022, compared to an increase from 0.4% to 6.4% among non-cancer cohort; similarly higher GLP-1RA use was observed in cancer than non-cancer cohort among MA beneficiaries in 2016-2021 (1.8% to 6.8% vs. 1.3% to 5.7%; unadjusted p-values < 0.001). Rapid uptake was observed for dulaglutide and semaglutide from 2015, while liraglutide use declined modestly after peaking in 2018. In adjusted analyses within the cancer cohort, patients with breast (0.87 percentage points [ppts], p < 0.001), female genital (1.08 ppts, p < 0.001), and prostate cancers (0.62 ppts, p = 0.001) were more likely to receive GLP-1RAs than those with colorectal cancer. More advanced cancer stage was associated with lower likelihoods of GLP-1RA use; Non-Hispanic White, higher socioeconomic neighborhoods, and dual eligibility were associated with higher likelihoods of GLP-1RAs use. Conclusions: GLP-1RA use increased substantially among Medicare beneficiaries with cancer and T2D, and was consistently higher than those without cancer, which may reflect greater clinical engagement and cardiometabolic risk burden following a cancer diagnosis. Variation by cancer site, stage, and socioeconomic factors suggest that both clinical complexity and structural determinants shape GLP-1RA use in cancer survivors.