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성균관대학교, 삼성서울병원

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Chest, July 26, 2026 | https://doi.org/10.1016/j.chest.2026.07.5208 Reduced Risk of Lung Cancer Associated with Sodium–Glucose Cotransporter-2 Inhibitors in Patients with COPD and Type 2 Diabetes Mellitus

Danbee Kang^1,2,3,∗ ∙ Jung-Wan Yoo^4,∗ ∙ Myeongcheol Lee^1,2,∗ ∙ Dae Hun Ryu² ∙ Hyun Myung Kang⁵ ∙ Sun Hye Shin⁵ ∙ Juhee Cho^1,2 ∙ Hye Yun Park^2,5

¹Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea (the Republic of)
²Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea (the Republic of)
³Trend sensing & risk modeling center, institution of cancer quality of life, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
⁴Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea (the Republic of)
⁵Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

^∗Drs. Danbee Kang, Jung-Wan Yoo and Myeongcheol Lee contributed equally as co-first authors.

Address correspondence to: Hye Yun Park

Abstract

Background
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer, and type 2 diabetes mellitus (T2DM) is a common comorbidity in COPD patients. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have pleiotropic effects beyond glucose lowering. However, their association with lung cancer risk in patients with COPD and T2DM remains uncertain.

Research Question
Is SGLT2 inhibitor initiation associated with a lower risk of incident lung cancer in patients with COPD and T2DM?

Study Design and Methods
We conducted a nationwide population-based cohort study using the National Health Insurance Database, including adults aged ≥40 years with COPD and T2DM who initiated SGLT2 inhibitors or sulfonylureas between September 2014 and December 2023. The primary outcome was incident lung cancer. Secondary outcomes included severe COPD exacerbation and all-cause mortality.

Results
Among 14,927 patients (5,651 SGLT2 inhibitor initiators and 9,276 sulfonylurea initiators), 234 incident lung cancer events occurred during a median follow-up of 2.97 years. The 4-year cumulative incidence of lung cancer was 1.6% in the SGLT2 inhibitor group and 2.7% in the sulfonylurea group. Initiation of SGLT2 inhibitors was associated with a lower risk of incident lung cancer compared with sulfonylureas (IPTW HR 0.73; 95% CI, 0.60–0.90). SGLT2 inhibitor use was also associated with reduced risks of severe COPD exacerbation (IPTW HR 0.77; 95% CI, 0.71–0.83) and all-cause mortality (IPTW HR 0.81; 95% CI, 0.75–0.88).

Interpretation
In this nationwide cohort of patients with COPD and T2DM, initiation of SGLT2 inhibitors was associated with lower risks of lung cancer, COPD exacerbation, and all-cause mortality compared with sulfonylureas.

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