Abstract
Purpose :
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are widely used for the management of diabetes mellitus (DM). SGLT2 is expressed by retinal pericytes, thus SGLT2 inhibition may prevent retinal pericyte loss and have a protective effect in diabetic retinopathy. By decreasing glucose in the retinal microcirculation, SGLT2 inhibitors may reduce glucose-induced endothelial dysfunction. This study aims to evaluate whether SGLT2 inhibitors affect progression of non-proliferative diabetic retinopathy (NPDR) compared to standard of care.
Methods :
A retrospective cohort study was conducted to compare subjects enrolled in a commercial and Medicare advantage medical claims database who filled a prescription for a SGLT2 inhibitor between the years 2013 to 2020 to unexposed controls, matched in a 1:3 ratio, who initiated an alternative diabetic anti-hyperglycemic agent. Patients were excluded if they were enrolled for less than two years in the plan, had no prior ophthalmologic exam, had no diagnosis of NPDR on or prior to the index date, had a diagnosis of diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR), had received treatment for vision threatening diabetic retinopathy (VTDR), or were younger than 18 years. To balance covariates of interest between the exposed and unexposed cohorts, an inverse probability treatment weighting (IPTW) propensity score for SGLT2 inhibitor exposure was used. Multivariate Cox proportional hazard regression modeling was employed to assess the hazard ratio (HR) for VTDR, PDR or DME relative to SGLT2 exposure.
Results :
A total of 6065 patients initiated a SGLT2 inhibitor were matched to 12890 controls. There were 734 (12%), 657 (10.8%) and 72 (1.18%) cases of VTDR, DME and PDR, respectively in the SGLT2 inhibitor cohort. Conversely, there were 1479 (11.4%), 1331 (10.3%), 128 (0.99%) cases of VTDR, DME and PDR, respectively in the control cohort. After IPTW, Cox regression analysis showed no difference in hazard for VTDR, PDR or DME in the SGLT2 inhibitor-exposed cohort relative to the unexposed group [HR=1.04, 95% CI 0.94 to 1.15 for VTDR; HR=1.03; 95% CI 0.93 to 1.14 for DME; HR=1.22; 95% CI 0.89 to 1.67 for PDR].
Conclusions :
Exposure to SGLT2 inhibitor therapy was not associated with progression of NPDR compared to patients receiving other diabetic therapies.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.