GLP-1 RA Prescribing in Older Adults With Diabetes and Cancer Tied Mainly to Metabolic Risk

Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) rose sharply among Medicare beneficiaries with type 2 diabetes and cancer from 2010 to 2022, and prescribing was primarily associated with metabolic risk profile, with limited association with cancer status, according to a retrospective cohort study published in JAMA Network Open.

The investigators noted that nearly all pivotal GLP-1 RA trials excluded patients diagnosed with cancer in the previous 5 years and that neither diabetes nor oncology guidelines address GLP-1 RA prescribing specifically for patients with cancer or cancer survivors. Using linked Surveillance, Epidemiology, and End Results (SEER)–Medicare data, they identified 373,278 beneficiaries with preexisting type 2 diabetes who were diagnosed with 1 of 7 common cancers at age 66 years or older and matched them 1:1 with noncancer controls with type 2 diabetes.

Under traditional Medicare, GLP-1 RA use increased from 0.5% to 8.2% in the cancer cohort and from 0.9% to 6.2% in the noncancer cohort, with a similar increase under Medicare Advantage. Unadjusted use was higher in the cancer cohort, but after adjustment for sociodemographic characteristics, comorbidities, and diabetes-related complications, the difference under traditional Medicare was not statistically significant (adjusted probability difference, 0.16 percentage points; 95% CI, −0.10 to 0.41). Under Medicare Advantage, adjusted use was modestly lower in the cancer cohort (−0.52 percentage points), a finding the authors described as hypothesis-generating.

Obesity, dyslipidemia, neuropathy, retinopathy, and chronic kidney disease were each associated with a greater likelihood of GLP-1 RA use. Within the cancer cohort, breast and prostate cancers (and, under Medicare Advantage, gynecologic cancer) were associated with higher use than colorectal cancer, whereas pancreatic cancer and more advanced stage at diagnosis were associated with lower use. Older age, Hispanic ethnicity, and non-Hispanic Black race were also associated with lower use.

The authors noted that claims often underrecord comorbidities, especially obesity; that the study could not separate active cancer treatment from survivorship or identify the prescribing clinician; and that the findings may not apply outside SEER regions or to younger patients. They called for studies of GLP-1 RA safety, efficacy, and outcomes throughout cancer care to guide oncology-specific prescribing recommendations.

Source: Hu X, Jiang C, Han X, et al. GLP-1 RA prescribing in patients with type 2 diabetes and cancer. JAMA Netw Open. 2026;9(10):e2640781. doi:10.1001/jamanetworkopen.2026.40781