Patients with type 2 diabetes prescribed sodium–glucose cotransporter 2 inhibitors were half as likely to require surgical treatment compared with those taking other antihyperglycemic medications, according to data presented at the 2025 CHEST Annual Meeting.
Among 218 patients with diabetes and confirmed lung nodules followed for 10 years, those prescribed sodium-glucose cotransporter 2 (SGLT2) inhibitors had a surgical intervention rate of 6% compared with 12% among patients taking alternative diabetes medications. The researchers calculated that treating 16 patients with an SGLT2 inhibitor could prevent one surgical procedure within a decade.
Nodule growth occurred in 14% of patients taking SGLT2 inhibitors compared with 26% of those prescribed other antihyperglycemic medications. Surgical interventions included biopsy, resection, radiotherapy, or chemotherapy.
The retrospective single-center study included adults with diabetes who had at least two computed tomography (CT) scans confirming a lung nodule between 2014 and 2024. Of the 218 participants, 109 were prescribed SGLT2 inhibitors and 109 received other classes of antihyperglycemic medications. Groups did not differ significantly in sex, race, or smoking history. Mean glycated hemoglobin (A1C) levels were higher among SGLT2 inhibitor users (7.7 vs 7.1), and follow-up duration was similar between groups.
Nodule growth was defined as an increase greater than 2 mm or the appearance of a solid component suggesting invasive disease. Interventions were defined as biopsy, resection, empiric radiotherapy, or chemotherapy. Data were analyzed using multivariable-adjusted Cox regression and log-rank testing.
The researchers observed that SGLT2 inhibitor use correlated with decreased progression of in-situ pulmonary adenocarcinomas and fewer surgical procedures. They emphasized that the findings warrant further investigation to clarify underlying mechanisms and to determine whether SGLT2 inhibitors could play a therapeutic role in early-stage pulmonary adenocarcinoma.
Researchers acknowledged that the retrospective design limited causal interpretation. Variations in imaging intervals, medication exposure, and adherence may have influenced outcomes. The single-center design may also limit generalizability.
“SGLT2 inhibitors may hold therapeutic potential for patients with early-stage pulmonary adenocarcinoma by slowing nodule growth and reducing the need for surgical interventions such as biopsies and resections,” said Katherine Welch, MD, University of Pennsylvania, lead investigator of the study (CHEST 2025; DOI:10.1016/j.chest.2025.07.2667).
The study was presented under the session Targeted Therapies, Tumor Biology, and Precision Approaches in Lung Cancer at the CHEST Annual Meeting 2025, hosted by the American College of Chest Physicians.
The authors reported no conflicts of interest.
