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A retrospective cohort study with a new-user and active-comparator design was conducted using the TriNetX US Network. Adults (\u2265\u200918 years) with Type 2 diabetes mellitus (T2DM) (<jats:italic>n<\/jats:italic>\u2009=\u20093,389,059) from January 1, 2005, to December 31, 2020, were identified. Two cohorts of new GLP-1 RA (<jats:italic>n<\/jats:italic>\u2009=\u2009201,153) and new dipeptidyl peptidase-4 inhibitor (DPP4i) (<jats:italic>n<\/jats:italic>\u2009=\u2009323,114) users were created. Propensity score matching was used to create comparable cohorts. The primary outcome was lung cancer, while other pulmonary conditions were secondary outcomes over a 10-year follow-up. Through 1:1 propensity score matching, two balanced cohorts of GLP-1 RA and DPP4i (<jats:italic>n<\/jats:italic>\u2009=\u2009158,224) users were created. GLP-1 RA users had a significantly lower risk of lung cancer than did DPP4i users (hazard ratios [HR] 0.86; 95% confidence interval [CI] 0.80\u20130.94). Reduced risk of influenza and pneumonia (HR 0.94; 95% CI 0.92\u20130.96) and pulmonary fibrosis (HR 0.92; 95% CI 0.87\u20130.98) were also noted in GLP-1 RA users. Our findings indicate that GLP-1 RAs may lower the risks of lung cancer, pulmonary fibrosis, and respiratory infections, meriting further prospective study.<\/jats:p>","DOI":"10.1038\/s41598-025-19657-5","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:23:14Z","timestamp":1760361794000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association between glucagon-like peptide-1 receptor agonist therapy and respiratory illness in patients with type 2 diabetes: a retrospective observational cohort study"],"prefix":"10.1038","volume":"15","author":[{"given":"Li-Ti","family":"Ho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Wei","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Sung","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Tong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Hsien","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"19657_CR1","doi-asserted-by":"publisher","first-page":"107","DOI":"10.2991\/jegh.k.191028.001","volume":"10","author":"MAB Khan","year":"2020","unstructured":"Khan, M. 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