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SGLT2 inhibitors for delaying diabetic retinopathy: a systematic review and meta-analysis

Saba Goodarzi1,2, Faezah Soltani Abhari3, Gelareh Azarinoush4

  • 1Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.

International Ophthalmology
|October 3, 2025
PubMed
Abstract

Insights

Sodium-glucose co-transporter 2 (SGLT2) inhibitors significantly reduce diabetic retinopathy (DR) progression and incidence in type 2 diabetes mellitus (T2DM) patients. These findings highlight SGLT2 inhibitors as a crucial element in managing T2DM and preventing vision loss.

Area of Science:

  • Endocrinology
  • Ophthalmology
  • Pharmacology

Background:

  • Diabetic retinopathy (DR) is a primary cause of vision loss in type 2 diabetes mellitus (T2DM).
  • Effective interventions are crucial for preventing DR progression.

Purpose of the Study:

  • To systematically review and evaluate sodium-glucose co-transporter 2 (SGLT2) inhibitors' role in predicting DR.
  • To assess the impact of SGLT2 inhibitors on DR progression and incidence.

Main Methods:

  • A comprehensive systematic review and meta-analysis adhering to PRISMA guidelines.
  • Inclusion of sixteen cohort studies with over 400,000 participants comparing SGLT2 inhibitors with other glucose-lowering therapies.
  • Searches conducted across major databases (PubMed, Embase, Cochrane, Web of Science, Scopus) up to December 8, 2024.

Main Results:

  • SGLT2 inhibitors significantly reduced DR progression (HR: 0.75; 95% CI: 0.67-0.85; p < 0.001) compared to other treatments, with substantial heterogeneity.
  • A modest but significant risk reduction for incident DR was observed (HR: 0.87; 95% CI: 0.79-0.97; p = 0.01).
  • Subgroup analyses indicated benefits over DPP-4 inhibitors, GLP-1 receptor agonists, and Sulfonylureas for progression, and over DPP-4 inhibitors for incidence.

Conclusions:

  • SGLT2 inhibitors demonstrate significant efficacy in reducing both the progression and incidence of diabetic retinopathy.
  • These findings support the use of SGLT2 inhibitors as a vital component in comprehensive T2DM management strategies.
  • Further high-quality, long-term randomized trials are recommended to validate these results and explore underlying mechanisms.
Keywords:
Diabetes complicationsDiabetic retinopathySGLT2 inhibitorsSodium-glucose transporter 2 inhibitors

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