This study will examine whether the type of diabetes treatment used before cancer diagnosis is associated with survival and serious complications after obesity-associated cancer in adults with obesity and type 2 diabetes. The study focuses on glucagon-like peptide-1 receptor agonists (GLP-1 RA) and compares them with other commonly used glucose-lowering therapies, including SGLT2 inhibitors, DPP-4 inhibitors, sulfonylureas, metformin, and usual care. Using de-identified electronic health record data from the TriNetX US Collaborative Network, the study will assess whether patients who used GLP-1 RA before cancer diagnosis have different risks of death, hospitalization, sepsis, and other major outcomes after cancer diagnosis. This is an observational study designed to evaluate associations in routine clinical care and not to prove a treatment effect.

Inclusion Criteria:

• Adults aged 18 years or older
• BMI ≥27 kg/m2, or diagnosis codes consistent with obesity
• Type 2 diabetes mellitus
• Initiation of a glucose-lowering medication before obesity-associated cancer diagnosis
• Incident obesity-associated cancer diagnosed after medication initiation
• No dispensing of the study drug class during the 6-month washout period before the first qualifying prescription

Exclusion Criteria:

• Type 1 diabetes mellitus, Other specified diabetes types that are not type 2 diabetes
• Human immunodeficiency virus infection
• End-stage renal disease
• Prior bariatric surgery
• Prior organ transplantation
• Transplant-related complications
• Any use of tirzepatide before cohort entry

Adults will be selected from the TriNetX US Collaborative Network, a distributed database of de-identified electronic health records contributed by participating healthcare organizations across multiple clinical systems and practice settings. The study population consists of adults with obesity and type 2 diabetes who received routine clinical care in this network and were identified through diagnosis records, body mass index data, and medication prescribing data. Comparator-specific cohorts were defined within this source population to evaluate pre-diagnosis glucose-lowering treatment strategies before obesity-associated cancer diagnosis.

Individual participant data will not be shared. This retrospective observational study uses de-identified electronic health record data from the TriNetX US Collaborative Network. Access to individual-level data is restricted by data use agreements, institutional policies, and privacy protections. Researchers who meet eligibility requirements may obtain access to similar de-identified data through a TriNetX license or through participating institutions.