A recent analysis of a large commercial database suggested that the class of diabetes medications known as sodium glucose co-transporter 2 (SGLT2) inhibitors, which includes well-known drugs such as empagliflozin (Jardiance) and dapagliflozin (Farxiga), could potentially provide more protection against diabetic retinopathy compared to other hypoglycemic agents. This study revealed that SGLT2 inhibitors were associated with a risk reduction of sight-threatening retinopathy by 21-39% when compared to GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas.
Interestingly, the analysis did not find an increased risk of diabetic neuropathy complications in patients who were treated with GLP-1 agonists, contrary to what had been suggested by previous findings. In fact, GLP-1 receptor agonists did not show an elevated risk relative to DPP-4 inhibitors and sulfonylureas in terms of vision-threatening diabetic retinopathy events. The relative risks between these drug classes were consistent regardless of the duration of use.
During the American Society of Retina Specialists (ASRS) meeting where these findings were presented, there were also discussions about other potential complications associated with these medications. A particular focus was placed on ischemic optic neuropathy and whether it was linked to the use of GLP-1 receptor agonists. The researchers acknowledged the need for further investigation to fully understand the benefits and potential risks of these powerful medications that can impact various aspects of systemic health.
The American Diabetes Association (ADA) highlighted the importance of considering SGLT2 inhibitors or GLP-1 receptor agonists for patients with type 2 diabetes and existing atherosclerotic cardiovascular disease, regardless of their glycemic control status. Over the years, the ADA has expanded its recommendations to include individuals with multiple cardiovascular risk factors, heart failure, chronic kidney disease, and obesity. Furthermore, the preferential use of a GLP-1 receptor agonist over starting insulin was emphasized.
Previous meta-analyses had shown no heightened risk of diabetic retinopathy with the use of SGLT2 inhibitors, GLP-1 agonists, or DPP-4 inhibitors when compared to a placebo. However, these studies were limited by short follow-up periods, narrow inclusion criteria, and a lack of direct comparisons between different medication classes. Preclinical research suggested that SGLT2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors have distinct effects on retinal microvasculature, inflammation, and neuroprotection that might extend beyond their glucose-lowering properties.
To further investigate potential inter-class differences in the risk of diabetic retinopathy, researchers analyzed data from the OptumLabs patient population. The study included patients who initiated treatment with either a GLP-1 receptor agonist, SGLT2 inhibitor, DPP-4 inhibitor, or sulfonylurea, excluding those with a history of diabetic macular edema or proliferative diabetic retinopathy. Results showed that SGLT2 inhibitors had the lowest risk of diabetic macular edema and/or proliferative diabetic retinopathy compared to the other drug classes.
The use of SGLT2 inhibitors may offer a protective advantage against the development of diabetic retinopathy, especially in comparison to other commonly utilized hypoglycemic agents. This research sheds light on the potential benefits of these medications beyond glycemic control and underscores the importance of further exploration into their effects on ocular health in diabetes management.
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