GLP-1 receptor agonists and diabetic retinopathy: A meta-analysis of randomized clinical trials

Area of Science:

• Ophthalmology
• Endocrinology
• Clinical Trials Research

Background:

• Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are standard treatments for type 2 diabetes mellitus.
• Emerging evidence suggests a potential link between GLP-1 RA use and diabetic retinopathy (DR) progression.
• Understanding this relationship is crucial for managing diabetes and its ocular complications.

Purpose of the Study:

• To investigate the association between FDA-approved GLP-1 RAs and the risk of diabetic retinopathy (DR).
• To compare DR rates and ocular adverse events across different GLP-1 RAs, placebo, insulin, and oral antidiabetic medications.
• To explore demographic and clinical factors influencing the GLP-1 RA impact on DR.

Main Methods:

• Systematic search of ClinicalTrials.gov for relevant trials involving FDA-approved GLP-1 RAs.
• Comparative analysis of DR rates, ocular adverse events, and patient characteristics across 93 trials.
• Subgroup analysis focusing on individual GLP-1 RAs, particularly albiglutide.

Main Results:

• GLP-1 RA use showed a significant association with increased risk of early-stage DR and retinal adverse events compared to placebo (RR=1.31, RR=1.29).
• GLP-1 RA use demonstrated a protective effect against late-stage DR when compared to insulin (RR=0.38).
• Albiglutide was identified as a key driver for these trends, increasing early-stage DR risk and decreasing late-stage DR risk.

Conclusions:

• The specific GLP-1 RA used significantly impacts the risk of developing early-stage or late-stage diabetic retinopathy.
• Albiglutide's distinct effects on DR progression warrant further investigation, considering its association with both increased early-stage and decreased late-stage DR.
• Patient demographic and clinical characteristics appear to modulate the influence of GLP-1 RAs on DR and ocular health.