Diabetes research and clinical practice · 2026
Meta-analysis of sodium glucose transport 2 inhibitors versus other glucose-lowering agents on the progression of diabetic retinopathy and diabetic macular edema.
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Akande Rukayat, Albert Stewart G
Аннотация
OBJECTIVE: While glycemic control reduces the progression of diabetic retinopathy (DR), the effects of specific glucose-lowering drugs (GLD) remain incompletely defined. Emerging evidence suggests that sodium-glucose cotransporter‑2 inhibitors (SGLT2i) may confer protective effects on DR and diabetic macular edema (DME).
RESEARCH DESIGN AND METHODS: We reviewed human studies comparing SGLT2i versus other GLD with primary outcomes of DR or DME. Random effects meta-analyses and meta-regression were performed to estimate relative risks (rr) and risk differences (rd) for retinopathy progression.
RESULTS: Of 273 identified studies, 16 met inclusion criteria, comprising 1,785,409 patients. Comparator subclasses included dipeptidyl peptidase-4 inhibitors (DPP-4i), Glucagon Like Peptide 1 -receptor agonists (GLP-1RA), sulfonylureas, and "other" GLD. SGLT2i therapy was associated with significantly lower rr of DR progression versus all GLD (rr = 0.77;95%CI:0.72,0.82,p < 0.001), and each of the subclasses. Similar reductions were observed for DME progression (rr = 0.75;95%CI:0.69,0.82,p < 0.001). Benefits were proportional to baseline rates; for cohorts with a 20%DR rate, the absolute rd was approximately 4%. The comparative benefit of SGLT2i was most pronounced versus sulfonylureas than to GLP-1RA and DPP-4i.
CONCLUSIONS: In patients with established DR or DME, SGLT2i may be preferred over DPP-4i and sulfonylureas, whereas choice of SGLT2i versus GLP-1RA should be guided by other comorbidities.
RESEARCH DESIGN AND METHODS: We reviewed human studies comparing SGLT2i versus other GLD with primary outcomes of DR or DME. Random effects meta-analyses and meta-regression were performed to estimate relative risks (rr) and risk differences (rd) for retinopathy progression.
RESULTS: Of 273 identified studies, 16 met inclusion criteria, comprising 1,785,409 patients. Comparator subclasses included dipeptidyl peptidase-4 inhibitors (DPP-4i), Glucagon Like Peptide 1 -receptor agonists (GLP-1RA), sulfonylureas, and "other" GLD. SGLT2i therapy was associated with significantly lower rr of DR progression versus all GLD (rr = 0.77;95%CI:0.72,0.82,p < 0.001), and each of the subclasses. Similar reductions were observed for DME progression (rr = 0.75;95%CI:0.69,0.82,p < 0.001). Benefits were proportional to baseline rates; for cohorts with a 20%DR rate, the absolute rd was approximately 4%. The comparative benefit of SGLT2i was most pronounced versus sulfonylureas than to GLP-1RA and DPP-4i.
CONCLUSIONS: In patients with established DR or DME, SGLT2i may be preferred over DPP-4i and sulfonylureas, whereas choice of SGLT2i versus GLP-1RA should be guided by other comorbidities.