The effects of SGLT2 inhibitors on corneal neuroinflammation in type 2 diabetes

Abstract

Purpose : To determine the impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on corneal neuroinflammation by evaluating corneal dendritic cell density in patients with type 2 diabetes.

Methods : Corneal dendritic cell densities were assessed in the central cornea and inferior whorl using in vivo corneal confocal microscopy in participants with type 2 diabetes treated with SGLT2 inhibitor (T2DM - SGLT2i, 23) and those not treated with SGLT2 inhibitors (T2DM - no SGLT2i, 23) as wel as 24 age- and sex-matched healthy controls. The two diabetes groups were matched for age, Total Neuropathy Score, duration of diabetes, body mass index, Lipid profile and HBA1c. The Kruskal-Wallis H test was used to compare the difference between the three groups, and Dunn-Bonferroni was used for all pairwise comparisons, which adjusted for multiple comparisons.

Results : In the central cornea, the T2DM - no SGLT2i group had significantly more dendritic cells than both the T2DM - SGLT2i group [mature (p = 0.03), immature (p = 0.06) and total (p = 0.002)] and the healthy control group [mature (p = 0.04), immature (p = 0.004) and total (p = 0.002)]. In the inferior whorl, the T2DM - no SGLT2i group had significantly more mature dendritic cells than the T2DM - SGLT2i group (p = 0.02), but no significant differences in immature (p = 0.27) and total dendritic cell densities (p = 0.16). There were no significant differences in mature (p > 0.99) and immature (p > 0.99) dendritic cell densities between T2DM-SGLT2i and healthy controls. No differences in total dendritic cell density were observed in the central cornea (p = 0.09) or the inferior whorl (p = 0.88) between T2DM - SGLT2i and healthy control groups.

Conclusions : Participants with type 2 diabetes taking SGLT2 inhibitors had decreased corneal dendritic cell density when compared to those not taking these medications, and were no different to controls, while those with type 2 diabetes not treated with SGLT2 inhibitors had significantly more dendritic cells than the healthy control group. Corneal dendritic cell evaluation appears to indicate an improvement in corneal neuroinflammation with the use of SGLT2 inhibitors in patients with type 2 diabetes.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Dendritic cells in CCM image