June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Glucagon-like peptide-1 receptor agonists are associated with decreased risk of progression from non-proliferative diabetic retinopathy to vision threatening diabetic retinopathy
Author Affiliations & Notes
  • Zujaja Tauqeer
    Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
  • Peter Bracha
    Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
    Gundersen Eye Institute, Gundersen Health System, La Crosse, Wisconsin, United States
  • Peiying Hua
    Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Qi N Cui
    Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
  • Brian L VanderBeek
    Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
    Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Zujaja Tauqeer, None; Peter Bracha, None; Peiying Hua, None; Qi Cui, Neuraly, Inc (F), Penn Center for Innovation (P); Brian VanderBeek, None
  • Footnotes
    Support  University of Pennsylvania Core Grant for Vision Research (2P30EY001583)
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1122. doi:
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      Zujaja Tauqeer, Peter Bracha, Peiying Hua, Qi N Cui, Brian L VanderBeek; Glucagon-like peptide-1 receptor agonists are associated with decreased risk of progression from non-proliferative diabetic retinopathy to vision threatening diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1122.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Glucagon-like peptide-1 receptor (GLP1R) agonists are a class of incretin mimetics used to treat type 2 diabetes by augmenting insulin release and sensitivity. Despite improved glycemic control, clinical trials have shown a transient worsening of diabetic retinopathy in some patients treated with GLP1R agonists. We examined this paradoxical worsening and assessed risk for progression of nonproliferative diabetic retinopathy (NPDR) to vision-threatening diabetic retinopathy (VTDR), and in particular, proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME).

Methods : A retrospective cohort of patients with NPDR newly started on a GLP1R agonist from a national insurance claims database was compared to a cohort of patients treated with other oral agents and matched for age, sex, race, index year, and number of active diabetic medications. Exclusion occurred for <2 years in database before diagnosis; prior diagnosis of PDR, DME, vitreous hemorrhage, other retinal vascular diseases; or prior VTDR treatment. Primary outcomes were incidence of VTDR, PDR, and DME. Inverse probability of treatment weight (IPTW) was used within a multivariable Cox proportional hazard regression model to test the association between GLP1R agonist exposure and progression to VTDR, PDR and DME. IPTW was derived from a propensity score model based on Diabetic Complications Severity index, hemoglobin A1c (HbA1c), demographic factors and systemic health conditions. HbA1c was modeled in a time-updating fashion.

Results : 3,668 GLP1R users meeting inclusion criteria were matched to 4,821 unexposed controls. In the GLP1R cohort, 132 (3.6%), 22 (0.6%) and 118 (3.2%) patients progressed to VTDR, PDR and DME, respectively. This compared to 353 (7.3%) VTDR, 156 (3.2%) PDR, and 242 (5.0%) DME patients in the control group. Accounting for underlying DM severity with IPTW, GLP1R agonist use conferred a reduced hazard of developing VTDR (hazard ratio [HR] = 0.44, 95% CI: 0.38-0.50, p<0.001), PDR (HR = 0.16, 95% CI: 0.12-0.22, p<0.001), and DME (HR = 0.57, 95% CI: 0.49-0.66, p<0.001).

Conclusions : GLP1R agonist use was associated with statistically significant and clinically meaningful reductions in progression from NPDR to VTDR, PDR, and DME. These results may have implications in treatment choice for patients with diabetic retinopathy.

This is a 2021 ARVO Annual Meeting abstract.

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