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Nasopharyngeal Carcinoma and Head and Neck Cancer in Type 2 Diabetes after SGLT2I, DPP4I, and GLP1a Use

Lifang Li1, Oscar Hou-In Chou2, Kar Kei Mak3

  • 1Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.

Cancer Prevention Research (Philadelphia, Pa.)
|May 22, 2025
PubMed

Insights

Sodium glucose cotransporter 2 inhibitors (SGLT2I) may lower nasopharyngeal carcinoma (NPC) risk in type-2 diabetes mellitus patients compared to dipeptidyl peptidase-4 inhibitors (DPP4I). This study found no significant association with other head and neck cancers.

Area of Science:

  • Oncology
  • Endocrinology
  • Epidemiology

Background:

  • Nasopharyngeal carcinoma (NPC) is endemic in Asia with distinct risk factors.
  • Anti-diabetic drugs are being investigated for their potential role in reducing NPC risk.
  • The comparative effects of sodium glucose cotransporter 2 inhibitors (SGLT2I) and dipeptidyl peptidase-4 inhibitors (DPP4I) on NPC and head and neck (H&N) cancer risk in type-2 diabetes mellitus (T2DM) patients are unknown.

Purpose of the Study:

  • To investigate the association between SGLT2I and DPP4I use and the risk of developing NPC and other H&N cancers among T2DM patients.
  • To compare the risks of NPC and H&N cancer in T2DM patients treated with SGLT2I versus DPP4I.

Main Methods:

  • A population-based cohort study was conducted in Hong Kong involving T2DM patients treated between January 1, 2015, and December 31, 2019.
  • Propensity score matching (1:1 ratio) was used to balance covariates between SGLT2I and DPP4I users.
  • Multivariable Cox regression analysis was employed to assess the risk of new-onset NPC and H&N cancer.

Main Results:

  • The study included 75,884 T2DM patients (28,778 on SGLT2I, 47,106 on DPP4I), with 57,556 matched patients in the final analysis.
  • After matching, 106 patients developed NPC and 50 developed H&N cancer.
  • SGLT2I use was associated with a significantly lower risk of NPC (HR: 0.41; 95% CI: 0.21-0.81) compared to DPP4I, but not with H&N cancer (HR: 1.00; 95% CI: 0.26-3.92).

Conclusions:

  • Real-world evidence suggests SGLT2I use is associated with a reduced risk of NPC compared to DPP4I in T2DM patients.
  • No significant association was found between SGLT2I use and the risk of other H&N cancers compared to DPP4I.
  • Further research is needed to confirm these findings and elucidate the biological mechanisms involved.

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