Anti-diabetic medications and cancer: links beyond glycemic and body weight control

Abstract

Cancer is becoming one of the leading causes of death among patients with diabetes. Hyperglycemia and obesity, two key characteristics of type 2 diabetes, modify the risks of cancer in patients with type 2 diabetes. However, recent studies suggested that glycemic control and weight loss mediated by anti-diabetic medications might not be sufficient to lower the risks of cancer in patients with type 2 diabetes. Thus, there is a need to explore the association between anti-diabetic medications and cancer beyond glycemic and body weight control. This review has summarized the preclinical and clinical evidence between various anti-diabetic drugs and cancer. More importantly, this review focused on the underlying links between anti-diabetic medications and cancer beyond glycemic and body weight control, including modified cell proliferation, altered levels of some hormones, inflammation and oxidative stimuli, autophagy and apoptosis, intestinal flora shift, and angiogenesis and epithelial-mesenchymal transition. This review may provide insights for future clinical and mechanistic studies to further elucidate the association between anti-diabetic medications and cancer.

Keywords

type 2 diabetes / cancer / anti-diabetic medications

Acknowledgments

This work was supported by the 2024 National Clinical Key Specialty Construction Program of China (Department of Endocrinology, Peking University People’s Hospital) with support from the central government budget, the Noncommunicable Chronic Diseases-National Science and Technology Major Project (grant Nos. 2023ZD0508200, 2023ZD0508205), the Clinical Medicine Plus X-Young Scholars Project of Peking University (grant No. PKU2025PKULCXQ025), and the Fundamental Research Funds for the Central Universities. The funding agencies had no roles in the study design, data collection or analysis, decision to publish, or preparation of the manuscript.

Author contributions

Meng Cao (Writing—original draft, Writing—review & editing), Chu Lin (Conceptualization, Writing—original draft, Writing—review & editing), Xiaoling Cai (Conceptualization, Writing—original draft, Writing—review & editing), Fang Lv (Investigation), Wenjia Yang (Investigation), and Linong Ji (Investigation).

Conflict of interest

L.J. has received fees for lecture presentations and for consulting from Merck, Metabasis, AstraZeneca, MSD, Novartis, Roche, Eli Lilly, Sanofi-Aventis, and Takeda. No other support from any organization for the submitted work has been received other than that described. The other authors declare no conflict of interest.

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