From the Department of Ophthalmology (K.M.W., E.K., C.A.L., P.M., E.R.), Byers Eye Institute, Stanford University, Palo Alto, California, USA.
Department of Ophthalmology, UCI Health (K.M.), Gavin Herbert Eye Institute, Irvine, California, USA.
Am J Ophthalmol. 2024 Sep;265:39-47. doi: 10.1016/j.ajo.2024.04.010. Epub 2024 Apr 17.
To examine the effects of glucagon-like peptide-1 receptor (GLP-1) agonists compared to SGLT-2 inhibitors on diabetic retinopathy.
Retrospective clinical cohort study using TriNetX, a federated electronic health records network comprising multiple healthcare organizations.
Patients with an International Classification of Diseases, Tenth Revision (ICD-10) code of nonproliferative diabetic retinopathy (PDR) and monotherapy treatment, excluding insulin, with GLP-1 agonists or SGLT-2 inhibitors. Patients with a history of PDR prior to initiation of treatment were excluded. The rate of progression to PDR and rate of development of diabetic macular edema (DME) were compared between patients on GLP-1 agonists compared to those on SGLT-2 inhibitors. The groups were propensity score matched for age, gender, ethnicity, race, type of diabetes, and severity of PDR. Main outcomes included rate and relative risk (RR) of progression to PDR and risk of DME in the GLP-1 agonist group versus the SGLT-2 inhibitor group.
A total of 6481 patients were identified in the GLP-1 cohort and the SGLT-2 inhibitor cohort after propensity score matching. At 1 and 3 years after initiation of therapy, a higher rate of progression of PDR was noted (RR: 1.26, CI 1.04-1.51, P = .017 at 1 year, RR: 1.284, CI 1.1-1.499, P = .002 at 3 years) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort. There was a higher rate of DME noted at 3 months (RR: 1.192, CI 1.059-1.276, P = .002), 6 months (RR: 1.22, CI 1.13-1.32, P < .001), 1 year (RR: 1.24, CI 1.15-1.33, P < .001), and at 3 years (RR: 1.29, CI 1.21-1.38, P < .001) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort.
A higher rate of progression of PDR and risk of new-onset DME was observed in patients on monotherapy with GLP-1 agonists compared to those on SGLT-2 inhibitors. It is important for clinicians to be aware of these potential effects and to consider the current retinopathy status when initiating treatment with newer hypoglycemic agents to ensure these patients are appropriately monitored for developing potential vision-threatening complications.
研究胰高血糖素样肽-1 受体（GLP-1）激动剂与 SGLT-2 抑制剂相比对糖尿病视网膜病变的影响。
使用 TriNetX 进行回顾性临床队列研究，TriNetX 是一个由多个医疗机构组成的联邦电子健康记录网络。
患者有国际疾病分类，第十版（ICD-10）非增殖性糖尿病视网膜病变（PDR）的编码和单一疗法治疗，不包括胰岛素，使用 GLP-1 激动剂或 SGLT-2 抑制剂。在开始治疗前有 PDR 病史的患者被排除在外。比较 GLP-1 激动剂治疗组和 SGLT-2 抑制剂治疗组患者进展为 PDR的比率和发生糖尿病性黄斑水肿（DME）的比率。对年龄、性别、种族、种族、糖尿病类型和 PDR 严重程度进行倾向评分匹配。主要结局包括 GLP-1 激动剂组与 SGLT-2 抑制剂组之间进展为 PDR 的比率和 DME 的风险以及相对风险（RR）。
在进行倾向评分匹配后，GLP-1 组和 SGLT-2 抑制剂组共确定了 6481 例患者。在治疗开始后 1 年和 3 年，GLP-1 激动剂组进展为 PDR 的比率更高（RR：1.26，CI 1.04-1.51，P =.017 在 1 年，RR：1.284，CI 1.1-1.499，P =.002 在 3 年）与 SGLT-2 抑制剂组相比。在 3 个月（RR：1.192，CI 1.059-1.276，P =.002）、6 个月（RR：1.22，CI 1.13-1.32，P <.001）、1 年（RR：1.24，CI 1.15-1.33，P <.001）和 3 年（RR：1.29，CI 1.21-1.38，P <.001），GLP-1 激动剂组比 SGLT-2 抑制剂组发生 DME 的比率更高。
与 SGLT-2 抑制剂相比，GLP-1 激动剂单药治疗的患者 PDR 进展和新发 DME 的风险更高。临床医生了解这些潜在影响非常重要，在开始使用新的降血糖药物治疗时，应考虑当前的视网膜病变状况，以确保这些患者得到适当监测，以避免潜在的威胁视力的并发症。
