IMPORTANCE: Tirzepatide, recently FDA-approved for weight loss, offers substantial metabolic benefits, yet its long-term impact on diabetic retinopathy (DR) remains unclear OBJECTIVE: To compare risk of diabetic retinopathy diagnoses, progression, and need for ocular interventions between patients using tirzepatide and matched patients receiving lifestyle intervention alone.
DESIGN, SETTING, AND PARTICIPANTS: Population-based, retrospective cohort study using the TriNetX US Collaborative Network. Patients with diabetes and overweight or obesity who initiated tirzepatide were included. Each tirzepatide patient was propensity score matched to a similar patient who received lifestyle-intervention alone and had no exposure to weight-loss drugs.
EXPOSURE: Initiation of tirzepatide MAIN OUTCOMES AND MEASURES: Onset of DR, progression to more severe stages of DR, or need for interventions, such as intravitreal anti-VEGF injection and pan-retinal photocoagulation.
RESULTS: After propensity matching for demographic, metabolic, and systemic covariates, 173 846 patients were included in the analysis (86 923 per cohort; mean [SD] age, 56.9 [12.7] years; 86 740 [52.0 %] women). Tirzepatide use was associated with reduced 12 month risk of diabetic-retinopathy incidence and worsening events than the lifestyle intervention alone cohort, including incident mild NPDR (RR, 0.864 [0.758-0.985], proliferative DR (RR, 0.705 [0.564-0.882]), DR with macular-edema (RR, 0.624 [95 % CI, 0.536-0.727], vitreous hemorrhage (RR, 0.607 [0.429-0.860]), tractional retinal detachment (RR, 0.370 [0.179-0.765] intravitreal anti-VEGF injection (RR, 0.479 [0.368-0.625]),and pan-retinal photocoagulation (RR, 0.610 [0.403-0.924]) CONCLUSIONS AND RELEVANCE: Tirzepatide was associated with a lower incidence of new or progressive diabetic retinopathy and fewer complications, including those requiring interventions, compared with lifestyle intervention alone. These findings may inform treatment selection for in patients at risk for diabetic retinopathy.
GLP-1 Therapies