Patient satisfaction and adherence to tuberculosis treatment among adults in the National Tuberculosis Program-Uganda: a cross sectional study.

We searched PubMed and Embase from Jan 1, 2010, to March 31, 2025, using the terms “SGLT2 inhibitor” AND (“breast cancer” OR “metastasis” OR “cancer outcomes”), with no language restrictions. Preclinical studies demonstrated that SGLT2 inhibitors activate AMPK and inhibit tumour cell proliferation. One observational study reported delayed hormone therapy failure in prostate cancer with SGLT2 inhibitor use. A melanoma mouse model showed reduced liver metastasis with SGLT2 inhibition via disruption of insulin-dependent PI3K/AKT signalling. However, no study had examined the association between SGLT2 inhibitor use and distant metastasis risk in breast cancer, and no investigation had evaluated organ-specific metastasis patterns in this context. Using a target trial emulation framework with 7138 propensity score-matched patients with breast cancer and type 2 diabetes, we found that SGLT2 inhibitor use was associated with a 32·4% reduction in distant metastasis risk over five years. Protection was organ-specific: strongest for liver and lung metastasis, significant for bone, and non-significant for brain metastasis. An independent exploratory transcriptomic analysis revealed that clinical protection corresponded to the degree of metabolic hyperactivity at each metastatic site, a pattern that is directionally consistent with a plausible biological basis, pending experimental validation.