SGLT2 Inhibitors May Offer Better Protection Against Diabetic Retinopathy – Renal and Urology News

The risk of progressing to sight-threatening diabetic retinopathy appears lower with use of sodium-glucose cotransporter 2 (SGLT2) inhibitors than other second-line glucose-lowering medications, investigators report.

In propensity score-matched analyses, new users of SGLT2i had a significant 43%, 38%, and 25% lower risk of vision-threatening retinopathy compared with new users of dipeptidyl peptidase-4 inhibitors (DPP-4i), sulfonylureas, and pioglitazone, respectively, Chii-Min Hwu, MD, of Taipei Veterans General Hospital in Taiwan, and colleagues reported in JAMA Network Open. Results were similar for empagliflozin, dapagliflozin, and canagliflozin. Sight-threatening retinopathy was defined as at least 2 outpatient visits or 1 hospitalization for diabetic retinopathy that required surgery, laser photocoagulation, or anti-VEGF injections (ranibizumab, bevacizumab, or aflibercept) within 90 days of diagnosis or vision loss.

Kaplan-Meier analyses revealed that the cumulative incidence of sight-threatening retinopathy (per 1000 person-years) was significantly lower among SGLT2i users compared with DPP-4i (3.52 vs 6.13), pioglitazone (4.32 vs 5.76), and sulfonylurea (2.94 vs 4.67) users.

“In addition to playing a role in reducing the risk of diabetic nephropathy, SGLT2i may be associated with the slow progression of diabetic retinopathy,” according to Dr Hwu’s team.

For the study, investigators analyzed data from Taiwan’s 2009-2020 National Health Insurance Research Database (NHIRD). They identified 3,544,383 patients with newly diagnosed type 2 diabetes. After 1:1 propensity score matching, the investigators identified 65,930 pairs of patients treated with SGLT2i vs DPP-4i, 93,760 pairs treated with SGLT2i vs pioglitazone, and 42,121 pairs treated with SGLT2i vs sulfonylurea.

The NHIRD lacked information on relevant factors such as family history, smoking history, laboratory values, and retinal imaging, so data from randomized controlled trials are needed.

Reference

Yen FS, Wei JC, Yu TS, Hung YT, Hsu CC, Hwu CM. Sodium-glucose cotransporter 2 inhibitors and risk of retinopathy in patients with type 2 diabetes. JAMA Netw Open. Published online December 20, 2023. doi:10.1001/jamanetworkopen.2023.48431