Key message:
A comprehensive analysis of an extensive electronic health record data set revealed that diabetic patients undergoing treatment with GLP-1 agonists faced an increased risk of developing diabetic macular edema and a greater likelihood of progressing to proliferative diabetic retinopathy compared to those receiving SGLT-2 inhibitors. Despite the considerable cardiovascular and renal advantages offered by GLP-1 agonists in diabetic patients, healthcare providers must remain aware of the potential influence of these medications on diabetic eye disease. This awareness is vital to ensure optimal management of patients with diabetes.
Summary:
Aim:
To examine the effects of GLP-1 agonists compared with SGLT-2 inhibitors in diabetic retinopathy.
Design:
Retrospective clinical cohort study using TriNetX (Cambridge, MA, USA), a federated electronic health record network comprising multiple healthcare organizations.
Methods:
Patients with an International Classification of Diseases, Tenth Revision (ICD-10) code for nonproliferative diabetic retinopathy and monotherapy treatment, excluding insulin, with GLP-1 agonists or SGLT-2 inhibitors. Patients with a history of proliferative diabetic retinopathy before the start of treatment were excluded. The rate of progression to proliferative diabetic retinopathy and the rate of development of diabetic macular edema were compared between patients receiving GLP-1 agonists and those receiving SGLT-2 inhibitors. Groups were propensity score matched for age, gender, ethnicity, race, type of diabetes, and severity of nonproliferative diabetic retinopathy. Main outcomes included the rate and relative risk of progression to proliferative diabetic retinopathy and the risk of diabetic macular edema in the GLP-1 agonist group versus the SGLT-2 inhibitor group.
Results:
A total of 6481 patients were identified in the GLP-1 agonist cohort and the SGLT-2 inhibitor cohort after propensity score matching. At 1 and 3 years after the start of therapy, a higher rate of progression of proliferative diabetic retinopathy was observed (RR: 1.26, CI 1.04-1.51, p=0.017 at 1 year, RR: 1.284, CI 1.1- 1.499, p=0.002 at 3 years) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort. A higher rate of diabetic macular edema was observed at 3 months (RR: 1.192, CI 1.059-1.276, p=0.002), 6 months (RR: 1.22, CI 1.13-1.32, p<0.001), 1 year (RR: 1.24, CI 1.15-1.33, p<0.001), and at 3 years (RR: 1.29, CI 1.21-1.38, p<0.001) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort .
Conclusions:
A higher rate of progression of proliferative diabetic retinopathy and risk of new onset diabetic macular edema was observed in patients on monotherapy with GLP-1 agonists compared to those on SGLT-2 inhibitors. It is important for clinicians to be aware of these potential effects and consider the current status of retinopathy when initiating treatment with newer hypoglycemic agents to ensure that these patients are adequately monitored for potential vision-threatening complications.
Fountain: BioPress
