AAO 2023: Effect of GLP-1 Receptor Agonists on Diabetic Retinopathy

Lauren Kiryakoza, MD
Bascom Palmer Eye Institute, Miami, FL

The second day of retina sub day at AAO 2023 included talks on the increasingly popular glucagon-like peptide (GLP-1) agonists such as semaglutide (Ozempic), dulaglutide (Trulicity), and liraglutide (Saxenda). Dr. Aleksandra Rachitskaya highlighted the interest in the potential relationship between the GLP-1 agonist medications and diabetic retinopathy (DR). Large studies, such as REWIND and LEADER, examined cardiovascular outcomes among patients with diabetes receiving GLP-1 agonists. They also reported that they found no association between GLP-1 agonists and DR progression. SUSTAIN 6, another large study, reported a higher risk of DR progression than placebo. These large studies primarily examined cardiovascular outcomes, not DR. Dr Rachitskaya also points out that the studies had inconsistent and limited documentation of DR staging, so she and her team sought to explicitly study the relationship between the medications and DR. She notes endocrinologists may express concern and seek ophthalmology guidance regarding the appropriateness of GLP-1 agonists in patients with known DR given these reports.

Dr. Rachitskaya and team conducted a retrospective study of 981 patients with diabetes to determine if worsening DR stage was related to GLP-1 agonists. Clinically worsening DR was determined by reviewing the electronic medical record (EMR) for each patient over the study period. Charts labeled with a clinically worsening DR stage as designated by ICD 10 code in the EMR were independently confirmed by a retina specialist. 692 of the 981 patients were being treated with GLP-1 receptor agonists and 289 were receiving treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors). The patient characteristics in both groups were similar except for the baseline BMI, which was higher among the GLP-1 agonist group compared to the SGLT2 inhibitor group. One primary outcome was clinically worsening events (for example: any NPDR to PDR) based on ICD 10 code in the EMR. Results showed no significant difference in clinically worsening events between the groups after mean treatment of approximately 286 days in the GLP-1 agonist group and 259 days in the SGLT2 inhibitor group. Limitations of the study include a relatively small representation of SGLT2 inhibitor use and overall limited sample. Prospective studies of the possible relationship between these increasingly prescribed medications and DR would be beneficial.