Abstract
Purpose :
Diabetic Retinopathy (DR), the foremost microvascular complication of Type 2 Diabetes Mellitus (T2DM), ranks as the leading cause of vision loss in working-age adults. However, the role of hypoglycemic medications in the onset and progression of DR among T2DM remains unclear. This retrospective case-control study aims to delineate the impact of hypoglycemic medications on the risk and timing of DR onset following T2DM diagnosis.
Methods :
We utilized data from the nationwide Cerner Health Facts electronic health record database (2000-2018). Case and control groups were distinguished through phenotyping with specialized eMERGE algorithms. Treatment strategies were selected based on expertise and data-driven methods for prevalent medications. The association between medication use and the risk of developing DR after T2DM diagnosis was examined using Cox Proportional Hazards models. Kaplan-Meier (KM) survival analysis was employed to compare the duration free from DR between treatment and non-treatment groups. To account for potential confounders, we employed propensity score matching to balance age, gender, race, body mass index (BMI), comorbid conditions, and initial levels of HbA1c and glucose among study groups.
Results :
Among 1,108,965 T2DM patients, 38,091 (3.4%) were assigned to the DR group (cases) and 25,676 (2.3%) to the DR-free group (controls). Treatment was associated with a 37% reduction in the risk of developing DR (HR=0.63; 95% CI=0.61-0.65; p<0.001) and with prolonged DR-free periods (Median=2,184 days; 95% CI=2,109-2,250), compared with the non-treatment group. (Median=522 days; 95% CI=509-537). After matching, 11,165 were assigned to cases and 6,929 to controls. Treatment was associated with 22% lower risk (aHR=0.78; 95% CI=0.75-0.81; p < 0.001) of developing DR. In matched cases, the median time to DR onset was 890 days for the treatment group, compared with 491 days for the non-treatment group.
Conclusions :
The results indicate that early initiation of hypoglycemic medication therapy in T2DM patients may prevent or delay the development of DR. We are planning to study the effect of anti-diabetic medications and other factors on the development of glaucoma, ocular hypertension, cataracts, and macular degeneration.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.