Multicenter retrospective cohort study of SGLT2 inhibitors in patients with cancer and type 2 diabetes mellitus

In China, the prevalence of type 2 diabetes mellitus (T2DM) in cancer patients is 24.4%; 2.3-fold higher than in the general population. Antineoplastic therapies, e.g., anthracyclines and VEGFR inhibitors, increase cardiorenal toxicity, exacerbated by T2DM. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) benefit non-oncologic populations but are understudied in T2DM-cancer patients. A multicenter retrospective cohort study in China assessed SGLT2i’s effect on antineoplastic therapy related cardiorenal toxicity in a cohort of 248 T2DM-cancer patients (56% male, mean age 66.7 years), 1:1 divided into a SGLT2i group and a non-SGLT2i group. Over 30.4 months of follow-up, SGLT2i use was associated with fewer cardiovascular events (OR 0.139; p=0.018) and all-cause mortality (HR 0.153; p<0.001). Echocardiography showed improved left ventricular ejection fraction and reduced left ventricular end-diastolic diameter/left atrial dimensions. SGLT2i preserved renal function and reduced uric acid levels. Benefits persisted across solid tumor/hematological malignancies and anthracycline-based therapy, targeted antineoplastic therapy, or immunotherapy subgroups, with no increase in infection. The authors conclude that SGLT2i improve cardiorenal outcomes and survival in T2DM-cancer patients, warranting prospective validation.