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Sodium-Glucose Cotransporter 2 Inhibitors and Risk of Retinopathy in Patients With Type 2 Diabetes

Fu-Shun Yen1, James Cheng-Chung Wei2,3,4, Teng-Shun Yu5,6

  • 1Private practice, Taoyuan, Taiwan.

JAMA Network Open
|December 20, 2023
PubMed
Abstract

Insights

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) significantly reduced the risk of sight-threatening retinopathy in type 2 diabetes patients compared to other common medications. This suggests SGLT2is may protect against diabetic retinopathy progression.

Area of Science:

  • Endocrinology
  • Ophthalmology
  • Pharmacology

Background:

  • Diabetic nephropathy and retinopathy share similar pathophysiological pathways.
  • Preclinical data indicate sodium-glucose cotransporter 2 inhibitors (SGLT2is) may offer protection against diabetic retinopathy.

Purpose of the Study:

  • To compare the risk of sight-threatening retinopathy in type 2 diabetes (T2D) patients treated with SGLT2is versus other second-line glucose-lowering agents.
  • Investigated SGLT2is against pioglitazone, sulfonylureas, and dipeptidyl peptidase-4 inhibitors (DPP-4is).

Main Methods:

  • A new-user, active-comparator cohort study in Taiwan using national health insurance data.
  • Propensity score matching identified comparable patient groups treated with SGLT2i vs. DPP-4i, pioglitazone, or sulfonylureas.
  • Cox proportional hazards regression analyzed the risk of sight-threatening retinopathy.

Main Results:

  • SGLT2i use was associated with a significantly lower risk of sight-threatening retinopathy compared to DPP-4i (AHR, 0.57), pioglitazone (AHR, 0.75), and sulfonylureas (AHR, 0.62).
  • Kaplan-Meier analysis confirmed a lower cumulative incidence of retinopathy with SGLT2i treatment across all comparisons.
  • Over 3.5 million T2D patients were initially identified, with over 200,000 propensity score-matched pairs analyzed.

Conclusions:

  • Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are associated with a reduced risk of sight-threatening retinopathy in type 2 diabetes patients.
  • These findings support a potential role for SGLT2is in mitigating diabetic retinopathy progression, similar to their known benefits in diabetic nephropathy.

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