GLP ‐ 1RA and the risk of non‐arteritic anterior ischaemic optic neuropathy in patients with type 2 diabetes: A population‐based study
Authors' conclusion
In this large observational study, the initiation of GLP-1RA was associated with an 85% increase in the risk of presumed NAION, compared with the initiation of SGLT2is, though incidence rates and absolute increase in risk were small.
Study context
- Population
- Adult initiators with T2D without prior ischemic optic neuropathy or other optic nerve disorders; insurance claims data, 01/2016–08/2024482,912 matched pairs
- Exposure
- GLP-1RA vs SGLT2i initiation
- Outcome
- Incident presumed NAION (diagnosis of ischemic optic neuropathy (ION) without other causes of optic neuropathy, plus ophthalmologist or optometrist visit on the same day)
- Follow-up
- Median 6.7 months on treatment
Methodological detailsnew-user active comparator design, target trial emulation, propensity score matched (1:1), three insurance claims databases
- New-user active comparator design
- Target trial emulation
- Propensity score matched (1:1)
- Three insurance claims databases
Main finding
As reported in the abstract
Incident NAION · median 6.7 months on treatment
Each group vs SGLT2iHazard ratio (95% CI)
GLP-1RA
1.85(1.51–2.27)
Each group vs SGLT2iRD, per 1000 person-years (95% CI)
GLP-1RA
0.29(0.19–0.39)
Observational data: associations, not effects.
Further findings
Meta-analysis of semaglutide analysis with previously published results: NAION
| HR (CI) | ||
|---|---|---|
| SemaglutideElevated risk | 2.78 (1.39–5.56) | |
| 0.20.5125Hazard ratio (log scale) |
Subgroups and sensitivity analyses
- Results were consistent across subgroups and sensitivity analyses
Original publication
GLP ‐ 1RA and the risk of non‐arteritic anterior ischaemic optic neuropathy in patients with type 2 diabetes: A population‐based study. Diabetes Obes Metab. Published 17 October 2025. doi:10.
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