Optimising renal risk parameters in type 2 diabetes mellitus: Perspectives from a retinal viewpoint

Area of Science:

• Endocrinology
• Ophthalmology
• Nephrology

Background:

• Diabetic retinopathy and nephropathy share underlying pathophysiological mechanisms.
• Suboptimal glycemic control correlates with the severity of these microvascular complications.
• Sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) demonstrate renal protection.

Purpose of the Study:

• To explore the applicability of SGLT2i and GLP-1RA reno-protective properties to diabetic retinopathy.
• To discuss the paradoxical early worsening of diabetic retinopathy with improved glycemic control.
• To investigate why newer SGLT2i may not exhibit this phenomenon.

Main Methods:

• Literature review and discussion of existing research on diabetic microvascular complications.
• Analysis of pathophysiological mechanisms linking renal and retinal protection.
• Exploration of clinical observations regarding glycemic control intensification and diabetic retinopathy progression.

Main Results:

• Sudden glycemic control improvement can transiently worsen pre-existing diabetic retinopathy, particularly with longer diabetes duration, higher HbA1c, rapid glucose reduction, and intensified therapy.
• This paradoxical progression is less frequently observed with newer SGLT2 inhibitors.
• Shared mechanisms suggest potential for translating renal protection strategies to the retina.

Conclusions:

• The reno-protective effects of SGLT2i and GLP-1RA warrant investigation for diabetic retinopathy.
• Understanding the transient worsening phenomenon is crucial for managing diabetic retinopathy during glycemic control intensification.
• Future research should focus on translating renal protection mechanisms to retinal health in diabetes.