Semaglutide and diabetic retinopathy: an OHDSI network study
Authors' conclusion
We did not identify increased risk for either PDR or treatment-requiring DR/DME comparing semaglutide with other GLP-1RAs or non-GLP-1RAs. Patients with T2D should still undergo close eye care follow-up, particularly when initiating new antihyperglycemic medications.
Study context
- Population
- Adults with T2D, 14 databases (6 claims, 8 EHR) in the OHDSI Evidence Network, 1 December 2017 to 31 December 2023810,390 semaglutide users
- Exposure
- Semaglutide vs other GLP-1 RA (dulaglutide) and non-GLP-1 RA (empagliflozin, sitagliptin, glipizide) as second-line T2D treatment
- Semaglutiden = 810,390
- Outcome
- Proliferative DR (PDR) and treatment-requiring diabetic retinopathy (DR)/diabetic macular edema (DME)
Methodological detailsactive-comparator new-user design, propensity score-adjusted Cox models, multicentre network (14 databases), random-effects meta-analysis
- Active-comparator new-user design
- Propensity score-adjusted Cox models
- Multicentre network (14 databases)
- Random-effects meta-analysis
Main finding
As reported in the abstract
PDR
Hazard ratio (95% CI)P value
Semaglutidevs Dulaglutide
0.81(0.42–1.54)
P = 0.51Semaglutidevs Empagliflozin
0.83(0.53–1.30)
P = 0.41Semaglutidevs Sitagliptin
0.83(0.45–1.55)
P = 0.57Semaglutidevs Glipizide
0.59(0.39–0.88)
P = 0.01Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Treatment-requiring DR/DMESemaglutidevs Empagliflozin | 0.66 (0.43–1.02) | P = 0.06 | |
| Treatment-requiring DR/DMESemaglutidevs Dulaglutide | 0.53 (0.31–0.91) | P = 0.02 | |
| Treatment-requiring DR/DMESemaglutidevs Sitagliptin | 0.46 (0.26–0.81) | P = 0.008 | |
| Treatment-requiring DR/DMESemaglutidevs Glipizide | 0.55 (0.33–0.91) | P = 0.02 | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Semaglutide and diabetic retinopathy: an OHDSI network study. BMJ Open Diabetes Res Care. Published 4 November 2025. doi:10.
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