肺癌 (LC) 是美国第二大常见癌症，也是癌症死亡的主要原因。胰岛素治疗是治疗 2 型糖尿病 (T2DM) 的关键疗法，与 LC 风险增加相关。非胰岛素抗糖尿病药物，特别是 GLP-1 受体激动剂 (GLP-1RA) 对 LC 风险的影响尚不清楚。这项研究评估了 T2DM 患者的 LC 风险，将七种非胰岛素抗糖尿病药物与胰岛素进行了比较。使用 TriNetX Analytics 平台，我们分析了 2005 年至 2019 年间接受治疗的 1,040,341 名 T2DM 患者的去识别化电子健康记录，不包括既往使用过抗糖尿病药物或 LC 诊断的患者。我们计算了 LC 风险的风险比和置信区间，并使用倾向评分匹配来控制混杂因素。与胰岛素相比，除 α-葡萄糖苷酶抑制剂外，所有非胰岛素抗糖尿病药物均与 LC 风险显着降低相关，其中 GLP-1RA 降低幅度最大（HR：0.49，95% CI：0.41，0.59）。在所有组织学类型、种族、性别和吸烟状况中，GLP-1RA 始终与降低 LC 风险相关。这些发现表明，非胰岛素抗糖尿病药物，特别是 GLP-1RA，可能更适合治疗 T2DM，同时降低 LC 风险。

Lung cancer (LC) is the second most common cancer and the leading cause of cancer deaths in the U.S. Insulin therapy, a key treatment for managing Type 2 Diabetes Mellitus (T2DM), is associated with increased LC risk. The impact of non-insulin antidiabetic drugs, particularly GLP-1 receptor agonists (GLP-1RAs), on LC risk is not well understood. This study evaluated LC risk in T2DM patients, comparing seven non-insulin antidiabetic agents to insulin. Using the TriNetX Analytics platform, we analyzed the de-identified electronic health records of 1,040,341 T2DM patients treated between 2005 and 2019, excluding those with prior antidiabetic use or LC diagnoses. We calculated hazard ratios and confidence intervals for LC risk and used propensity score matching to control for confounding factors. All non-insulin antidiabetic drugs, except alpha-glucosidase inhibitors, were associated with significantly reduced LC risk compared to insulin, with GLP-1RAs showing the greatest reduction (HR: 0.49, 95% CI: 0.41, 0.59). GLP-1RAs were consistently associated with lowered LC risk across all histological types, races, genders, and smoking statuses. These findings suggest that non-insulin antidiabetic drugs, particularly GLP-1RAs, may be preferable for managing T2DM while reducing LC risk.