Glucagon-Like Peptide-1 Receptor Agonists are Not Associated with an Increased Risk of Progressing to Vision-Threatening Diabetic Retinopathy

Oct 10, 2024Ophthalmic epidemiology

Drugs that activate GLP-1 receptors are not linked to higher risk of severe diabetic eye disease

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Abstract

Among 6093 users of GLP-1 receptor agonists, 10.1% progressed to vision-threatening diabetic retinopathy.

Progression rates for vision-threatening diabetic retinopathy (VTDR), proliferative diabetic retinopathy (PDR), and diabetic macular edema (DME) were 10.1%, 1.2%, and 8.9%, respectively, in the GLP-1 receptor agonist group.
In the control group, 9.5% progressed to VTDR, 1.2% to PDR, and 8.1% to DME.
No significant difference in the risk of progression to VTDR, DME, or PDR was observed between GLP-1RA users and controls after accounting for diabetes severity.
Hazard ratios for progression to VTDR, DME, and PDR were 1.02, 1.06, and 0.81, respectively, indicating similar risks between the groups.

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PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are used to treat type 2 diabetes mellitus (DM) by augmenting insulin release and sensitivity. We assessed the overall risk for development of vision-threatening diabetic retinopathy (VTDR), proliferative diabetic retinopathy (PDR), and diabetic macular edema (DME), among GLP-1RA users.

METHODS: A retrospective cohort of patients with NPDR newly started on a GLP-1RA from a national insurance claims database was compared to a cohort of patients treated with other oral anti-diabetic agents and matched for age, sex, race, index year, and number of active diabetic medications. Exclusions occurred for < 2 years in the database before diagnosis; prior diagnoses of PDR, DME, vitreous hemorrhage, and/or other retinal vascular diseases; and prior intraocular treatment for VTDR.

RESULTS: A total of 6093 users of GLP-1RA were matched to 14,122 controls. In the GLP-1RA cohort, 632 (10.1%), 76 (1.2%), and 544 (8.9%) patients progressed to VTDR, PDR, or DME, respectively. This is compared to 1332 (9.5%) VTDR, 165 (1.2%) PDR, or 1148 (8.1%) DME in the control group. Accounting for underlying DM severity with IPTW, no difference in hazard was seen in the GLP-1RA cohort compared to controls for progression to VTDR (HR = 1.02, 95%CI: 0.92-1.14 = 0.69), DME (HR = 1.06, 95%CI: 0.95-1.1.9, = 0.31), or PDR (HR = 0.81, 95%CI: 0.58-1.12, = 0.20). p p p

CONCLUSION: We found no difference in the risk for vision-threatening diabetic retinopathy, nor for its component diseases, DME or PDR, with GLP-1RA use compared to other oral anti-hyperglycemic agents in patients with NPDR.

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Glucagon-Like Peptide-1 Receptor Agonists are Not Associated with an Increased Risk of Progressing to Vision-Threatening Diabetic Retinopathy

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