International ophthalmology · 2025
SGLT2 inhibitors for delaying diabetic retinopathy: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Goodarzi Saba, Soltani Abhari Faezah, Azarinoush Gelareh, Rafiei Mohammd Ali, Yousefian Hessam, Heidari Ehsan, Ekramipour Edris, Mirzaei Afshin, Namakin Kosar, Shafiee Arman
Аннотация
BACKGROUND: Diabetic retinopathy (DR) is a leading cause of vision loss among individuals with type 2 diabetes mellitus (T2DM), necessitating effective interventions to prevent disease progression. This systematic review was conducted to evaluate the potential role of sodium-glucose co-transporter 2 (SGLT2) inhibitors as predictive factors of DR.
METHODS: A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted up to December 8, 2024, following PRISMA guidelines. Studies reporting DR outcomes among SGLT2 inhibitor users compared to other glucose-lowering therapies were included.
RESULTS: Sixteen cohort studies involving over 400,000 participants were included. SGLT2 inhibitors significantly reduced the risk of DR progression compared to other treatments (HR: 0.75; 95% CI: 0.67-0.85; p < 0.001), despite substantial heterogeneity (I2 = 82.89%). Subgroup analyses showed significant benefits over DPP-4 inhibitors, GLP-1 receptor agonists, and Sulfonylureas. For incident DR, pooled data from eight studies demonstrated a modest but significant risk reduction (HR: 0.87; 95% CI: 0.79-0.97; p = 0.01; I2 = 74.9%). Subgroup analysis indicated benefit over DPP-4 inhibitors but not over GLP-1 RAs or placebo. No publication bias was detected (Egger's test p = 0.76), and sensitivity analyses confirmed the stability of results.
CONCLUSIONS: SGLT2 inhibitors significantly reduce the progression and incidence of diabetic retinopathy, underscoring their potential as a key component in comprehensive diabetes management. Further high-quality, long-term randomized trials are warranted to confirm these findings and elucidate underlying mechanisms.
METHODS: A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted up to December 8, 2024, following PRISMA guidelines. Studies reporting DR outcomes among SGLT2 inhibitor users compared to other glucose-lowering therapies were included.
RESULTS: Sixteen cohort studies involving over 400,000 participants were included. SGLT2 inhibitors significantly reduced the risk of DR progression compared to other treatments (HR: 0.75; 95% CI: 0.67-0.85; p < 0.001), despite substantial heterogeneity (I2 = 82.89%). Subgroup analyses showed significant benefits over DPP-4 inhibitors, GLP-1 receptor agonists, and Sulfonylureas. For incident DR, pooled data from eight studies demonstrated a modest but significant risk reduction (HR: 0.87; 95% CI: 0.79-0.97; p = 0.01; I2 = 74.9%). Subgroup analysis indicated benefit over DPP-4 inhibitors but not over GLP-1 RAs or placebo. No publication bias was detected (Egger's test p = 0.76), and sensitivity analyses confirmed the stability of results.
CONCLUSIONS: SGLT2 inhibitors significantly reduce the progression and incidence of diabetic retinopathy, underscoring their potential as a key component in comprehensive diabetes management. Further high-quality, long-term randomized trials are warranted to confirm these findings and elucidate underlying mechanisms.