Impact of glucagon‐like peptide‐1 receptor agonists on diabetic retinopathy: A meta‐analysis of clinical studies emphasising retinal changes as a primary outcome

🥉 Top 5% JournalSep 26, 2024Clinical & experimental ophthalmology

Effects of diabetes drugs that activate GLP-1 receptors on diabetic eye disease focusing on retina changes

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Abstract

Analysis of seven studies involving 242,537 patients showed a significantly decreased risk of developing diabetic retinopathy (DR) in those using glucagon-like peptide-1 receptor agonists (GLP-1RA) compared to insulin.

GLP-1RA use is associated with a reduced risk of DR incidence compared to insulin (risk ratio = 0.66).
No differences in the risk of DR complications were observed between GLP-1RA and insulin users.
There was no difference in the risk of DR incidence between GLP-1RA and oral antidiabetic medication (OAD) users.
GLP-1RA users exhibited a significantly increased risk of DR complications compared to OAD users (risk ratio = 1.39).
The increased risk of complications in GLP-1RA users may relate to rapid decreases in HbA1c levels, a factor that requires further study.

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BACKGROUND: To determine if glucagon-like peptide-1 receptor agonists (GLP-1RA) are associated with the development and progression of diabetic retinopathy (DR).

METHODS: A systematic search was conducted on PubMed, Cochrane Library, and Embase from inception to February 2024 to identify clinical studies reporting the development of and changes in DR as the primary outcome in patients with type 2 diabetes taking GLP-1RA, insulin, or oral antidiabetic medication (OAD). Two researchers independently completed the search and referred to a third as necessary. Data for meta-analysis was pooled using a random-effects model.

RESULTS: Analysis of seven studies representing 242 537 patients showed a significantly decreased risk of incidence of DR between GLP-1RA and insulin use (RR = 0.66, 95% CI (0.48, 0.91), p = 0.01). There was no difference in the risk of DR complications (e.g., vitreous haemorrhage, retinal detachment, or requiring treatment with intravitreal injections, lasers, vitrectomy). Between GLP-1RA and OAD use, there was no difference in the risk of incidence of DR, while there was a significantly increased risk of DR complications (RR = 1.39, 95% CI (1.07, 1.80), p = 0.01).

CONCLUSION: Our findings indicate no elevated risk of incidence of DR linked to GLP-1RA compared to insulin. In fact, GLP-1RA may offer potential advantages over insulin regarding the overall incidence of DR. The increased risk of DR requiring treatment and associated complications in the GLP-1RA group compared to OAD may be due to the transient progression of DR associated with a rapid decrease in HbA1c - a phenomenon not specific to GLP-1RA and warrants further investigation.

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