Joo Julia H, Sharma Neha, Shaia Jacqueline, Wu Anna K, Skugor Mario, Singh Rishi P, Rachitskaya Aleksandra V
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Ophthalmol Sci. 2024 May 6;4(6):100547. doi: 10.1016/j.xops.2024.100547. eCollection 2024 Nov-Dec.
The potential association between diabetic retinopathy (DR) worsening and glucagon-like peptide-1 receptor agonists (GLP-1RA) has affected therapeutic management of diabetic patients but remains controversial. This study compared rates of DR development or progression in patients on GLP-1RA to those on SGLT-2 inhibitors (SGLT-2I).
Retrospective cohort study.
Nine hundred eighty-one patients with diabetes mellitus taking GLP-1RA or SGLT-2I, the latter serving as controls, between 2012 and 2023.
Patients were one-to-one greedy matched by propensity scores on race/ethnicity, age, smoking status, baseline body mass index and hemoglobin A1c %, type of diabetes mellitus, baseline DR status and history of DR procedures, duration of drug use, whether they had taken both drug types, and change in hemoglobin A1c % after 1 year on the drug.
The primary outcome was clinical DR development or progression (termed "worsening") detected by International Classification of Diseases (ICD), 10th edition codes, confirmed by manual review, on GLP-1RA compared with SGLT-2I after propensity score matching. Secondary outcomes included DR worsening indicated by need for procedures due to complications, and time-to-first DR worsening event.
The study included 692 GLP-1RA users and 289 SGLT-2I users. The mean follow-up periods for GLP-1RA versus SGLT-2I use were 1.54 (standard deviation [SD] 1.82) years and 1.38 (SD 1.56) years, respectively. The rates of clinical worsening were 2.3% and 2.8%, respectively. After propensity score matching, an association was not identified between GLP1-RA and DR worsening neither clinically by ICD-10 codes (odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.11-1.03) nor by indication for procedures (OR = 0.50, 95% CI 0.13-2.00). Time-to-first DR worsening did not differ between the groups in Kaplan-Meier analysis. The most common type of clinical worsening event for both drug types was vitreous hemorrhage (43.7% and 50% of worsening events in GLP-1RA and SGLT-2I users, respectively). The most common DR procedure indicated was anti-VEGF injections (34% and 35% of GLP-1RA and SGLT-2I events, respectively).
Diabetic retinopathy worsening, either clinically or by procedures, was not associated with GLP-1RA compared with SGLT-2I, both before and after propensity score matching on all analyses, including time-to-first worsening event.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
糖尿病视网膜病变（DR）恶化与胰高血糖素样肽-1受体激动剂（GLP-1RA）之间的潜在关联影响了糖尿病患者的治疗管理，但仍存在争议。本研究比较了使用GLP-1RA的患者与使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2I）的患者发生DR或病情进展的比率。
回顾性队列研究。
2012年至2023年间981例服用GLP-1RA或SGLT-2I的糖尿病患者，后者作为对照。
根据种族/民族、年龄、吸烟状况、基线体重指数和糖化血红蛋白百分比、糖尿病类型、基线DR状态和DR治疗史、用药持续时间、是否同时使用过两种药物以及用药1年后糖化血红蛋白百分比的变化，通过倾向得分对患者进行一对一贪婪匹配。
主要结局是在倾向得分匹配后，通过国际疾病分类（ICD）第10版编码检测到的临床DR发生或进展（称为 “恶化”），经人工审核确认，比较GLP-1RA与SGLT-2I。次要结局包括因并发症需要进行治疗所表明的DR恶化，以及首次DR恶化事件的发生时间。
该研究纳入了692例GLP-1RA使用者和289例SGLT-2I使用者。GLP-1RA与SGLT-2I的平均随访时间分别为1.54（标准差[SD]1.82）年和1.38（SD 1.56）年。临床恶化率分别为2.3%和2.8%。在倾向得分匹配后，无论是通过ICD-10编码临床判断（优势比[OR]=0.33，95%置信区间[CI]：0.11-1.03）还是通过治疗指征判断（OR=0.50，95%CI 0.13-2.00），均未发现GLP-1RA与DR恶化之间存在关联。在Kaplan-Meier分析中，两组首次DR恶化的时间没有差异。两种药物最常见的临床恶化事件类型均为玻璃体积血（分别占GLP-1RA和SGLT-2I使用者恶化事件的43.7%和50%）。最常见的DR治疗指征是抗血管内皮生长因子（VEGF）注射（分别占GLP-1RA和SGLT-2I事件的34%和35%）。
在所有分析中，包括首次恶化事件的时间，无论是临床判断还是通过治疗判断，与SGLT-2I相比，GLP-1RA与DR恶化均无关联。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
