Exploring aggregated data from electronic health records.
Key message:
A comprehensive analysis of a large electronic health record dataset found that patients with diabetes treated with GLP-1 agonists face an increased risk of developing diabetic macular edema and a greater likelihood of progression to proliferative diabetic retinopathy compared with those receiving SGLT-2 inhibitors. Despite the significant cardiovascular and renal benefits offered by GLP-1 agonists in patients with diabetes, healthcare providers should be aware of the potential impact of these drugs on diabetic eye disease. This awareness is vital to ensure optimal management of patients with diabetes.
Summary:
Target:
To study the effects of GLP-1 agonists versus SGLT-2 inhibitors in diabetic retinopathy.
Design:
Retrospective clinical cohort study using TriNetX (Cambridge, MA, USA), a federated electronic health record network of multiple healthcare organizations.
Methods:
Patients with International Classification of Diseases, Tenth Revision (ICD-10) code for nonproliferative diabetic retinopathy and receive monotherapy other than insulin with GLP-1 agonists or SGLT-2 inhibitors. Patients with a history of proliferative diabetic retinopathy before treatment were excluded. The rate of progression of proliferative diabetic retinopathy and the rate of development of diabetic macular edema were compared between patients treated with GLP-1 agonists and patients treated with SGLT-2 inhibitors. The groups were propensity score matched based on age, sex, ethnicity, race, type of diabetes, and severity of nonproliferative diabetic retinopathy. Primary outcomes included the incidence and relative risk of progression of proliferative diabetic retinopathy and the risk of diabetic macular edema in the GLP-1 agonist group compared with the SGLT-2 inhibitor group.
Results:
A total of 6481 patients were identified in the GLP-1 agonist cohort and the SGLT-2 inhibitor cohort after propensity score matching. At 1 and 3 years after the start of therapy, a higher rate of progression of proliferative diabetic retinopathy was observed (HR: 1.26, CI 1.04-1.51, p = 0.017 at 1 year, HR: 1.284, CI 1.1-1.499, p=0.002 at 3 years) in the GLP-1 agonist group compared with the SGLT-2 inhibitor group. A higher incidence of diabetic macular edema was observed at 3 months (HR: 1.192, CI 1.059-1.276, p=0.002), 6 months (HR: 1.22, CI 1.13-1.32, p<0.001), 1 year (OR: 1.24). , CI 1.15–1.33, p<0.001) and at 3 years (HR: 1.29, CI 1.21–1.38, p<0.001) in the GLP-1 agonist cohort compared with the SGLT inhibitor cohort -2.
Conclusions:
A higher rate of progression of proliferative diabetic retinopathy and the risk of new onset diabetic macular edema were observed in patients receiving GLP-1 agonist monotherapy compared with patients receiving SGLT-2 inhibitors. It is important for clinicians to be aware of these potential effects and consider the current status of retinopathy when initiating treatment with new hypoglycemic agents to ensure these patients are adequately monitored for potential vision-threatening complications.
Fountain: BioPress