Risk of diabetic retinopathy and diabetic macular oedema with sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in type 2 diabetes: a real-world data study from a global federated database

• DOI: 10.1007/s00125-024-06132-5
• Publication Date: 2024-04-08T03:10:07Z
• Authors: Aikaterini Elefth...; David Riley; Sizheng S. Zhao; Philip Austin; Gema Hernández; Gregory Y. H. Lip; Timothy L. Jackson; John P. H. Wilding; Uazman Alam
• Keywords: Male; Diabetes Mellitus, Type 2/drug therapy; Sodium-Glucose Transporter 2 Inhibitors/adverse effects; 610; Macular Edema/drug therapy; Middle Aged; Article; Hypoglycemic Agents/adverse effects; Microvascular disease; Insulin/adverse effects; Clinical Diabetes; Microvascular Disease; 616; Humans; Female; Diabetic Retinopathy/chemically induced; Retinopathy; Glucagon-Like Peptide-1 Receptor Agonists/adverse effects; Clinical diabetes; Aged; Retrospective Studies

Abstract Aims/hypothesis A protective role of sodium–glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP1-ra) in the development diabetic retinopathy macular oedema has been described some recent studies, which may extend beyond glycaemic control. We aimed to review clinical impact SGLT2i GLP1-ra therapy on risk individuals with type diabetes taking insulin. Methods This is a retrospective cohort analysis approximately two million people receiving insulin across 97 healthcare organisations using global federated health research network (TriNetX, Cambridge, USA). Two intervention cohorts (SGLT2i + insulin, n =176,409; =207,034) were compared against control (insulin no SGLT2i/GLP1-ra, =1,922,312). Kaplan–Meier survival was performed estimated HRs reported for each outcome. Propensity score used 1:1 match age, sex, ischaemic heart disease, hypertension, microvascular complications, chronic kidney HbA 1c , BMI use pioglitazone, lipid modifying agents, antilipemic ACE inhibitors, angiotensin II metformin. sub-analysis comparing also performed. Results associated reduced HR (95% CI) (0.835; 0.780, 0.893), while demonstrated lack signal statistical significance (1.013; 0.960, 1.069). not clinically significant increase developing (1.076; 1.027, 1.127), increased (1.308; 1.261, 1.357). Compared higher (1.205; 1.153, 1.259) (1.130; 1.056, 1.208). Conclusions/interpretation Our study suggests that combination lower oedema. However, an comparative showed favourable outcomes retinopathy. RCTs dedicated retinal imaging are required determine causal relationship these therapies. Graphical