Abstract
Purpose :
Although intravitreal vascular endothelial growth factor inhibitors (anti-VEGF) are first-line therapy for diabetic macular edema (DME), many patients with DME have little improvement despite receiving multiple rounds of injections. Newer oral hypoglycemic agents (nOHA), such as GLP-1 agonists, DPP-4 inhibitors, and SGLT2 inhibitors, have demonstrated neutral or beneficial effects in achieving good glycemic control as well as managing diabetic eye complications. Yet despite increasing use, few have investigated whether these effects translate to response to anti-VEGF treatment. This study tested the hypothesis that patients on nOHA in addition to anti-VEGF therapy would respond better than those not on nOHA.
Methods :
This was a retrospective single-center study of 121 patients (194 eyes) who received anti-VEGF treatment for DME between 2014 and 2022 with 24 months of follow up. Eyes were grouped into either being on nOHA (GLP-1 agonists, DPP-4 inhibitors, or SGLT2 inhibitors) or not (no nOHA). Demographic and ocular data were collected from the electronic medical record. Primary outcome measures were changes in best corrected visual acuity (BCVA) in logarithm of minimal angle of resolution (logMAR), central foveal thickness (CFT), and macular volume (MV) over a 24-month treatment period. Linear mixed models were used for statistical analysis.
Results :
Baseline demographics, including age, HbA1c, BMI, use of insulin, and ocular characteristics were not statistically significant between groups. From baseline to 12-months or baseline to 24-months, there were no significant differences in BCVA, CFT, or MV. From baseline to 12-months, looking at the nOHA vs. no nOHA groups respectively, the average change in BCVA was -0.20 vs. -0.04 logMAR (p=0.21), in CFT -116 vs. -52 µm (p=0.07), and in MV -0.83 vs.-0.39 mm3 (p=0.41). From baseline to 24-months, looking at the nOHA vs. no nOHA groups respectively, the average change in BCVA was -0.13 vs. -0.04 logMAR (p=0.55), in CFT -103 vs. -42 µm (p=0.13), and in MV -0.71 vs. -0.24 mm3 (p=0.43).
Conclusions :
Concurrent use of newer OHA was not associated with significant effects on BCVA, CFT, or MV in eyes receiving anti-VEGF injections over a 24-month period. Further work is needed to investigate what aspects may be affecting responsiveness to anti-VEGF therapy in patients with DME.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.