A recent analysis of a large commercial database has suggested that sodium glucose co-transporter 2 (SGLT2) inhibitors, such as empagliflozin (Jardiance) and dapagliflozin (Farxiga), may provide more protection against diabetic retinopathy compared to other hypoglycemic agents. The study indicated that SGLT2 inhibitors reduced the risk of sight-threatening retinopathy by 21-39% when compared to GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas. These findings were presented by Andrew J. Barkmeier, MD, at the American Society of Retina Specialists (ASRS) meeting.
According to Barkmeier, the use of SGLT2 inhibitors was associated with a lower risk of sight-threatening retinopathy when compared to other classes of glucose-lowering medications. Interestingly, GLP-1 receptor agonists did not show an increased risk relative to DPP-4 inhibitors and sulfonylureas. The relative risks among the different drug classes were consistent regardless of the duration of use.
During the presentation, there was a discussion regarding the potential complications associated with GLP-1 receptor agonists, particularly ischemic optic neuropathy. Barkmeier acknowledged the need for further research to better understand the benefits and risks of these medications. It was emphasized that these drugs have a significant impact on systemic health, requiring a comprehensive evaluation of their effects.
In 2019, the American Diabetes Association (ADA) recommended the use of SGLT2 inhibitors or GLP-1 receptor agonists for patients with type 2 diabetes and established atherosclerotic cardiovascular disease. These recommendations were independent of glycemic control status. Over the years, the ADA has expanded its guidelines to include patients with multiple cardiovascular risk factors, heart failure, chronic kidney disease, and overweight/obesity. Additionally, the use of a GLP-1 receptor agonist is preferred before initiating insulin therapy.
Previous meta-analyses have shown no increased risk of diabetic retinopathy for SGLT2 inhibitors, GLP-1 agonists, or DPP-4 inhibitors compared to placebo. However, Barkmeier highlighted the need for more comprehensive studies considering the unique effects of these drug classes on retinal health. Preclinical evidence suggests that SGLT2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors may have distinct effects on retinal microvasculature and inflammation, independent of their glucose-lowering properties.
To investigate potential inter-class differences in retinopathy risk, researchers analyzed data from the OptumLabs patient population. The study included patients who initiated treatment with a GLP-1 receptor agonist, SGLT2 inhibitor, DPP-4 inhibitor, or sulfonylurea and had no history of diabetic macular edema or proliferative diabetic retinopathy. The results indicated that SGLT2 inhibitors were associated with the lowest risk of diabetic macular edema and/or proliferative diabetic retinopathy, compared to the other drug classes.
The findings of this study suggest that SGLT2 inhibitors may offer superior protection against diabetic retinopathy compared to other hypoglycemic agents. While GLP-1 receptor agonists did not show an increased risk of retinopathy, further research is needed to fully understand the potential complications associated with these medications. Overall, the study highlights the importance of considering inter-class differences in diabetes management and the impact on ocular health.
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