Real-world Associations Between GLP-1 Receptor Agonist Use and Diabetic Retinopathy Accounting for Longitudinal Glycemic Control.

PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been identified as a potential risk factor for diabetic retinopathy onset and progression, although there is conflicting evidence. This longitudinal, retrospective cohort study determined associations between GLP-1 RA use and diabetic retinopathy (DR), diabetic macular edema (DME), and treatment-requiring DR/DME.

METHODS

Participants with type 2 diabetes mellitus were followed for 10 years from initial diagnosis. Survival analyses and Cox proportional hazards models adjusted for age, race and ethnicity, sex at birth, income, smoking, hypertension, insulin use, other antihyperglycemic agent use, body mass index, hemoglobin A1c, and change in HbA1c examined associations between GLP-1 RA use and incident DR, DME, and treatment-requiring DR/DME.

RESULTS

Compared to never users, GLP-1 RA use was associated with a decreased risk of DR (hazard ratio [HR]: 0.31, 95% confidence interval [CI]: 0.26 - 0.37, p<0.001), DME (HR: 0.40, 95% CI: 0.27 - 0.59, p<0.001), and treatment-requiring DR/DME (HR: 0.18, 95% CI: 0.08 - 0.40, p<0.001).

CONCLUSION

GLP-1 RA users were at a reduced risk of developing DR, DME, and treatment-requiring DR/DME. GLP-1 RA agents are likely protective of poor visual outcomes, though further research is needed to determine whether these medications remain protective when initiated after DR development.