Recent analysis of a large commercial database indicates that sodium glucose co-transporter 2 (SGLT2) inhibitors may provide better protection against diabetic retinopathy compared to other hypoglycemic agents. This analysis revealed a significant reduction in the risk of sight-threatening retinopathy when using SGLT2 inhibitors such as empagliflozin (Jardiance) and dapagliflozin (Farxiga). On the contrary, GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas showed similar risks of vision-threatening diabetic retinopathy events.
According to Dr. Andrew J. Barkmeier from the Mayo Clinic, the use of SGLT2 inhibitors was associated with a lower risk of sight-threatening retinopathy when compared to other classes of glucose-lowering medications. Additionally, there was no increased risk of diabetic neuropathy complications observed in patients treated with GLP-1 agonists. The relative inter-class risks remained consistent regardless of the duration of use.
During a session at the American Society of Retina Specialists (ASRS) meeting, specific concerns were raised regarding the potential adverse effects of different diabetes medication classes on diabetic retinopathy. Notably, the study did not show any evidence of ischemic optic neuropathy associated with the use of GLP-1 receptor agonists. Further investigations are needed to evaluate the broader systemic impact of these medications and to identify both benefits and potential complications.
The American Diabetes Association (ADA) has updated its recommendations over the past few years to include SGLT2 inhibitors or GLP-1 receptor agonists for patients with type 2 diabetes and established atherosclerotic cardiovascular disease. These recommendations extend to patients with multiple cardiovascular risk factors, heart failure, chronic kidney disease, and overweight/obesity. The ADA now suggests using a GLP-1 receptor agonist before starting insulin therapy.
Previous meta-analyses have shown no increased risk of diabetic retinopathy for SGLT2 inhibitors, GLP-1 agonists, or DPP-4 inhibitors when compared to a placebo. Preclinical studies indicate that these medication classes have distinct effects on retinal microvasculature, inflammation, and neuroprotection, which may go beyond their glucose-lowering properties. This suggests that there may be meaningful inter-class differences in the risk of diabetic retinopathy.
The analysis involved a large and diverse patient population to evaluate the impact of different diabetes medication classes on the incidence of diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). The findings revealed that SGLT2 inhibitors were associated with the lowest risk of DME and/or PDR compared to GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas. These differences were statistically significant, highlighting the potential benefits of SGLT2 inhibitors in reducing the risk of diabetic retinopathy complications.
The analysis discussed in this article sheds light on the potential benefits of SGLT2 inhibitors in reducing the risk of sight-threatening diabetic retinopathy. Further research and long-term studies are needed to fully understand the inter-class differences in the risk of diabetic retinopathy and to optimize treatment strategies for patients with diabetes.
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