OBJECTIVE: To compare the impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors and metformin on the risk of glaucoma-related outcomes in patients with type 2 diabetes mellitus (T2DM).
DESIGN: Multinational, retrospective clinical cohort study using patient data from 160 healthcare organizations across 21 countries.
SUBJECTS: Adults with T2DM who initiated SGLT2 inhibitors or metformin during 2013-2023 were included.
INTERVENTION: Patients with T2DM prescribed SGLT2 inhibitors were compared to those prescribed metformin. We performed 1:1 propensity score matching to balance age, sex, race, glycated hemoglobin, body mass index, medications, and comorbidities between the SGLT2 inhibitor and metformin groups.
MAIN OUTCOME MEASURE: The occurrence of ocular hypertension, primary open-angle glaucoma (POAG), and the need for glaucoma medications.
RESULTS: Our final analysis included 32 634 patients prescribed SGLT2 inhibitors and 32 634 prescribed metformin. Compared to metformin, SGLT2 inhibitors are associated with significantly lower risks of ocular hypertension (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.60-0.89), POAG (HR, 0.64; 95% CI, 0.51-0.81), and the need for glaucoma medications (HR, 0.76; 95% CI, 0.69-0.84) in 5 years. These associations remain consistent in patients aged ≥60 years, females, males, Whites, and those prescribed empagliflozin.
CONCLUSIONS: Among patients with T2DM, treatment with SGLT2 inhibitors may be associated with lower risks of ocular hypertension, POAG, and the need for glaucoma medications compared to metformin.
