Risk of diabetic retinopathy and diabetic macular oedema with sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in type 2 diabetes: a real-world data study from a global federated database
Authors' conclusion
Our study suggests that the combination of SGLT2i and insulin is associated with lower risk of developing diabetic macular oedema. However, the use of GLP1-ra was associated with an increased risk of diabetic retinopathy in individuals with type 2 diabetes also taking insulin. A comparative analysis showed favourable outcomes with SGLT2i and insulin in the development of diabetic macular oedema and diabetic retinopathy. RCTs using dedicated retinal imaging are required to determine the causal relationship with these therapies.
Study context
- Population
- People with T2D receiving insulin, 97 healthcare organisations (TriNetX global federated network)approximately two million
- Participants
- 176,409 / 207,034 / 1,922,312
- Exposure
- SGLT2i + insulin and GLP1-ra + insulin vs insulin without SGLT2i/GLP1-ra
- SGLT2i + insulinn = 176,409
- GLP1-ra + insulinn = 207,034
- Controln = 1,922,312reference
- Outcome
- Risk of DR and DME
Methodological detailsglobal federated health research network (TriNetX), 97 healthcare organisations, propensity-score matched 1:1
- Global federated health research network (TriNetX)
- 97 healthcare organisations
- Propensity-score matched 1:1
Main finding
As reported in the abstract
Each group vs controlHazard ratio (95% CI)
SGLT2i + insulinDME; reduced risk
0.835(0.780–0.893)
GLP1-ra + insulinDME; no statistical significance
1.013(0.960–1.069)
SGLT2i + insulinDR; not a clinically significant increase in risk
1.076(1.027–1.127)
GLP1-ra + insulinDR; increased risk
1.308(1.261–1.357)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Sub-analysis GLP1-ra + insulin vs SGLT2i + insulin: DR and DMEGLP1-ra + insulinvs SGLT2i + insulinDR; higher risk with GLP1-ra + insulin | 1.205 (1.153–1.259) | |
| Sub-analysis GLP1-ra + insulin vs SGLT2i + insulin: DR and DMEGLP1-ra + insulinvs SGLT2i + insulinDME; higher risk with GLP1-ra + insulin | 1.130 (1.056–1.208) | |
| 0.512Hazard ratio (log scale) |
Original publication
Risk of diabetic retinopathy and diabetic macular oedema with sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in type 2 diabetes: a real-world data study from a global federated database. Diabetologia. Published 8 April 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →