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Glucagon-Like Peptide 1 Receptor Agonists and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients

Yunha Noh1, Hui Yin2, Inès Ben Ghezala3,4,5

  • 1College of Pharmacy, Chonnam National University, Gwangju, South Korea.

Diabetes Care
|February 17, 2026
PubMed
Abstract

Insights

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) increase the risk of nonarteritic anterior ischemic optic neuropathy (NAION) in type 2 diabetes patients compared to DPP-4 inhibitors. This risk is higher in younger men, ever-smokers, and those with significant A1c reduction.

Area of Science:

  • Ophthalmology
  • Endocrinology
  • Pharmacovigilance

Background:

  • Type 2 diabetes management involves various medications with differing safety profiles.
  • Nonarteritic anterior ischemic optic neuropathy (NAION) is a serious ocular condition.
  • Understanding drug-associated risks is crucial for patient safety in diabetes care.

Purpose of the Study:

  • To compare the risk of incident NAION between new users of GLP-1 RAs and DPP-4 inhibitors in adults with type 2 diabetes.
  • To quantify the association between GLP-1 RA initiation and NAION risk.
  • To identify patient subgroups with potentially higher NAION risk on GLP-1 RAs.

Main Methods:

  • A new-user cohort study design was employed using the U.K. Clinical Practice Research Datalink.
  • Adult patients with type 2 diabetes initiating either GLP-1 RAs or DPP-4 inhibitors were included.
  • Propensity-score fine-stratification weighting was used to adjust for confounders and estimate risks, risk differences, and risk ratios.

Main Results:

  • GLP-1 RA initiators showed a higher incidence of NAION (18.5 per 100,000) compared to DPP-4 inhibitor initiators (7.2 per 100,000) at 1 year.
  • GLP-1 RAs were associated with a 2.56-fold increased risk (RR 2.56; 95% CI 1.44-4.86) of NAION.
  • Elevated NAION risk was observed within the first 6 months of GLP-1 RA use, particularly in patients <50 years, men, ever-smokers, and those with ≥1% HbA1c reduction.

Conclusions:

  • Initiation of GLP-1 RAs is associated with an increased 1-year risk of NAION compared to DPP-4 inhibitors in type 2 diabetes patients.
  • The risk appears more pronounced in specific subgroups, including younger individuals, males, ever-smokers, and those achieving significant glycemic control.
  • These findings highlight the need for careful consideration of NAION risk when prescribing GLP-1 RAs.

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