An increased rate of worsening DR in patients on GLP-1 agonists was found compared with SGLT-2 inhibitors.

An increased rate of worsening DR in patients on GLP-1 agonists was found compared with SGLT-2 inhibitors. Photo: Jay Haynie, OD. Click image to enlarge.

Newer oral hypoglycemic agents such as glucagon-like peptide-1 receptor (GLP-1) agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been increasingly used to treat diabetes, but not much is known about their effect on diabetic retinopathy (DR). In a study presented at ARVO in New Orleans last week, researchers aimed to assess the relationship between usage of novel hypoglycemic agents and their effect on DR and found an increased rate of worsening DR in patients on GLP-1 agonists compared with SGLT-2 inhibitors.

A retrospective cohort study was conducted using TriNetX, a federated electronic records research network that aggregates data from large health organizations within the United States. A total of 8,818 patients were included, with nonproliferative DR identified by ICD 9/10 codes and stratified by GLP-1 agonist use and SGLT-2 inhibitor use; 4,409 patients were in each cohort. Average ages were 64.1 vs. 63.9 and average HbA1c was 8.6% vs. 8.5% in the GLP-1 and SGLT-2 groups after matching, respectively. The primary outcome was conversion to proliferative DR and need for pars plana vitrectomy and was examined at one and five years after initiation of the agent and compared after propensity score matching.

At one and five years after initiation of the oral hypoglycemic agent, the GLP-1 group had higher rates of conversion to proliferative DR relative to the SGLT-2 group (3.9% vs. 3%; 6% vs. 4%). The GLP-1 agonist group had similar rates of vitrectomy surgery relative to the SGLT-2 inhibitor group (0.6% vs. 0.7%; 1% vs. 0.9%). The average HbA1c decreased in both the GLP-1 and SGLT-2 groups from baseline (7.9% vs. 8%; 7.9% vs. 8%).

The authors noted that clinicians should be aware of these effects when prescribing hypoglycemics to ensure proper monitoring and treatment for DR.

Original abstract content © Association for Research in Vision and Ophthalmology 2023.

Wai M, Ahluwalia A, Brant A, et al. Effect of next generation oral hypoglycemic agents on diabetic retinopathy progression: a national cohort study. ARVO 2023 annual meeting.