Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer significant benefits for patients with type 2 diabetes mellitus (T2DM), including improved glycemic control, weight reduction, cardiovascular protection, and reduced all-cause mortality, which are particularly relevant to breast cancer survivorship. Disparities in access may worsen inequities in care. Using the TriNetX national electronic health record database, we conducted a retrospective cohort study of 119,430 breast cancer patients with type 2 diabetes (2005-2024; mean age 66.1 ± 11.4 years; 67.2% White, 22.9% Black, 5.7% Asian, 4.2% Other). After propensity matching, compared with White patients, Asian (HR 0.64, 95% CI 0.58-0.71), Black (HR 0.78, 95% CI 0.75-0.81), and Other race patients (HR 0.90, 95% CI 0.83-0.97) were significantly less likely to receive GLP-1RAs. These disparities persisted among overweight and obese subgroups: Asian (HR 0.78, 95% CI 0.68-0.88), Black (HR 0.78, 95% CI 0.74-0.81), and Other patients (HR 0.83, 95% CI 0.72-0.95). These findings underscore the urgent need to address inequitable access to GLP-1RAs in breast cancer survivorship care.