Risk of Incident Colorectal Carcinoma in Patients With Type 2 Diabetes on SGLT-2 Inhibitor Users

Background: The role of sodium-glucose co-transporter-2 inhibitor (SGLT2I) in colorectal carcinoma (CRC) risk in patients with type 2 diabetes mellitus (T2D) remains controversial. This study aimed to examine the association between SGLT2I use and the risk of incident CRC in patients with T2D. Methods: This nationwide retrospective cohort study was conducted using the National Health Insurance Research Database (2015–2021). The primary outcome was the risk of incident CRC, estimated using hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression modeling was conducted to analyze the association between SGLT2I use and incident CRC risk in patients with T2D. Results: A total of 304 698 SGLT2I users and 609 396 nonusers were matched in a 1:2 ratio by age, sex, and index year from 2 617 996 patients with T2D. Among patients with T2D, 1436 and 3555 incident CRCs were recorded in SGLT2I users and nonusers, respectively. After adjusting for the index year, sex, age, and comorbidities, a significantly decreased risk of CRC was observed among SGLT2I users compared to nonusers (adjusted HR 0.80, 95% CI 0.74–0.85). The sensitivity test for the propensity score 1:1-matched analyses also showed similar results (adjusted HR 0.79, 95% CI 0.74–0.85). Conclusions: This population-based cohort study found that SGLT2I use was associated with a lower risk of CRC than nonuse of SGLT2I in patients with T2D. More studies are needed to evaluate the effects of SGLT2I therapy on CRC prevention in patients with T2D.