Glucagon-like Peptide-1 Receptor Agonists in the Management of Diabetic Retinopathy

Dec 23, 2024International ophthalmology clinics

Using Glucagon-like Peptide-1 Receptor Agonists to Manage Diabetes-Related Eye Disease

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Abstract

GLP-1 receptor agonists, particularly semaglutide, may be associated with worsening diabetic retinopathy in some patients.

GLP-1 receptor agonists modulate insulin release, gastric emptying, energy intake, and satiety.
Their efficacy and safety in treating type 2 diabetes and obesity have been shown in multiple large randomized controlled trials.
The effects of GLP-1 receptor agonists on diabetic retinopathy are currently unclear.
Some studies suggest potential worsening of diabetic retinopathy upon initiation of these medications.
The overall benefits in reducing cardiovascular and stroke risks may outweigh concerns regarding microvascular progression of diabetic retinopathy.

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Glucagon-like peptide-1 (GLP-1) receptor agonists are a family of drugs, most well known by the third-generation once-weekly subcutaneous semaglutide, that act on the incretin pathway of metabolic, hormonal signaling to modulate pancreatic insulin release, gastric emptying, energy intake, and subjective feelings of satiety. This class of drugs' efficacy and safety in the treatment of type 2 diabetes and obesity have been demonstrated across multiple large randomized controlled trials. These data have propelled GLP-1 receptor agonists to ubiquity in diabetic management and weight loss therapy, leading them to be frequently encountered in ophthalmic practice. The effect of GLP-1 receptor agonists like semaglutide on diabetic retinopathy (DR) is at this point unclear; some studies indicate a worsening of DR with the initiation of GLP-1 agonists, especially semaglutide. Overall, the macrovascular reduction of cardiovascular and stroke risks from GLP-1 receptor agonists should be prioritized over the potential microvascular progression of DR, as long as the patient is regularly followed by ophthalmology.

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Glucagon-like Peptide-1 Receptor Agonists in the Management of Diabetic Retinopathy

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