GLP-1 receptor agonists may increase incidence of diabetic retinopathy while reducing its complications

For individuals with type 2 diabetes (T2D), glucagon-like peptide 1 receptor agonist (GLP-1 RA) use is associated with a slightly increased risk for incident diabetic retinopathy (DR) and with a reduced risk for certain complications of DR, according to a study published online Aug. 11 in JAMA Network Open.

David J. Ramsey, M.D., Ph.D., M.P.H., from the UMass Chan-Lahey School of Medicine in Burlington, and colleagues conducted a retrospective cohort study to examine whether use of GLP-1 RAs in patients with T2D is associated with the development of DR, nonarteritic anterior ischemic optic neuropathy (NAION), or DR complications. Adults with T2D and a recent hemoglobin A1c level of 6.5% or higher were enrolled and divided into two groups through propensity score matching, based on whether they received prescriptions for a GLP-1 RA.

After propensity score matching, 185,066 individuals were prescribed GLP-1 RAs. The researchers found that GLP-1 RA use was associated with an increased incidence of DR (hazard ratio, 1.07), while no significant increase was seen in the risk for NAION. In a subgroup analysis of 32,695 patients with preexisting DR, there was no association seen for GLP-1 RAs with proliferative DR or diabetic macular edema, but associations were seen with a lower occurrence of vitreous hemorrhages, neovascular glaucoma, or blindness (hazard ratios, 0.74, 0.78, and 0.77, respectively).

“GLP-1 RAs may be a factor in reduced rates of vision loss leading to blindness, even among individuals with preexisting DR,” the authors write. “It is crucial that all patients with T2D treated with GLP-1 RAs, regardless of preexisting DR, receive regular screening and monitoring for potential complications of T2D.”

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