Abstract
Purpose :
Newer oral hypoglycemic agents such as glucagon-like peptide-1 receptor (GLP-1) agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been increasingly utilized in diabetes management. We aim to assess the relationship between usage of novel hypoglycemic agents and their effect on diabetic retinopathy (DR).
Methods :
A retrospective cohort study was conducted using TriNetX (Cambridge, MA, USA), a federated electronic records research network that aggregates data from large health organizations within the United States. Patients with non-proliferative DR (NPDR) were identified by ICD9/10 codes and stratified by GLP-1 agonist use and SGLT-2 inhibitor use. Patients with use of other oral hypoglycemics such as metformin or dipeptidyl peptidase-4 inhibitors within three months prior to initiation or within the study period were excluded. Cohorts were matched for age, gender, race, and baseline HbA1c level. The primary outcome was conversion to proliferative diabetic retinopathy (PDR) and need for pars plana vitrectomy (PPV). Outcomes were examined at one and five years after initiation of the oral hypoglycemic agent and were compared after propensity score matching.
Results :
A total of 8818 patients were included in the analysis with 4409 patients in each of the GLP-1 and SGLT-2 cohorts after propensity matching. The average age was 64.1 years vs. 63.9 years and average HbA1c was 8.6% vs 8.5% in the GLP-1 and SGLT-2 groups after matching, respectively. At one and five years after initiation of the oral hypoglycemic agent, the GLP-1 group had higher rates of conversion to PDR relative to the SGLT-2 group (3.9% vs. 3.0%, p=0.01 for one year; 6.0% vs 4.0%, p=<0.01 for five years). The GLP-1 agonist group had similar rates of vitrectomy surgery relative to the SGLT-2 inhibitor group (0.6% vs. 0.7%, p=0.69 for one year; 1.0% vs 0.9%, p=0.38 for five years). The average HbA1c decreased in both the GLP-1 and SGLT-2 groups from baseline (7.9% vs 8.0%, p<0.01 at one year; 7.9% vs 8.0%, p<0.01 for five years).
Conclusions :
Within a large real-world database, patients on GLP-1 agonists were found to have increased conversion rates to PDR, but similar rates of PPV compared to patients on SGLT-2 inhibitors. It is important for the clinician to be aware of these effects when initiating treatment with hypoglycemic agents to ensure appropriate monitoring for DR.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.