Investigating the association between incretin-based therapies and thyroid cancer incidence among US Medicare beneficiaries with diabetes
Authors' conclusion
Our study of US Medicare beneficiaries with type 2 diabetes suggests that the initiation of incretin-based therapies may not increase the 3-year risk of TC compared with initiation of SGLT-2i. This finding offers reassurance for short-term use but does not eliminate the possibility of increased long-term or subtype-specific risks.
Study context
- Population
- US Medicare beneficiaries (older adults) with T2D; GLP-1RA vs SGLT-2i cohort: mean age 72.4 years, men 48.3%; DPP-4i vs SGLT-2i cohort: mean age 74.6 years, men 44.9%new users
- Exposure
- Incretin-based therapies vs SGLT2i
- Outcome
- Thyroid cancer incidence (thyroidectomy followed by ≥2 separate diagnosis codes for malignant neoplasm of thyroid gland within 90 days); adjusted cumulative risk difference
- Follow-up
- 3 years
Methodological detailsnew-user design, weighted analysis
- New-user design
- Weighted analysis
Main finding
As reported in the abstract
Thyroid cancer
Adjusted risk difference
−23 per 10 000
95% CI −51 to 4
GLP-1RA · GLP-1RA vs SGLT-2i cohort, n = 73 388
Adjusted risk difference
−2 per 10 000
95% CI −17 to 13
DPP-4i · DPP-4i vs SGLT-2i cohort, n = 106 274
Observational data: associations, not effects.
Further findings
- Secondary and sensitivity analyses were consistent
Original publication
Investigating the association between incretin-based therapies and thyroid cancer incidence among US Medicare beneficiaries with diabetes. BMJ Open Diabetes Res Care. Published 6 October 2025. doi:10.
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