Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Incident Diabetic Retinopathy.

Antonios Douros, Kristian B Filion, Hui Yin, Oriana Hoi Yu, Mahyar Etminan, Jacob A Udell, Laurent Azoulay

REVIEW


16 April 2019

This study has a large cohort of patients newly diagnosed retinpathy, finding that GLP-1 agonists confer no greater risk of diabetic retinopathy compared with others. More research is definitely needed here - particularly (as the authors' suggest) in relation to length of therapy. It's a shame that linkage to national retinopathy screening is not yet available with the CPRD.


RELEVANCE 3
INNOVATIVENESS 3
APPLICABILITY 2
OVERALL 3

PAPER DETAILS


TITLE

Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Incident Diabetic Retinopathy.

ABSTRACT

OBJECTIVE
Previous studies suggested that glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may initially worsen and possibly increase the risk of diabetic retinopathy. However, data on this possible association remain limited. Thus, this population-based study aimed to determine whether use of GLP-1 RAs is associated with an increased risk of incident diabetic retinopathy.

RESEARCH DESIGN AND METHODS
Using the U.K. Clinical Practice Research Datalink (CPRD), we conducted a cohort study among 77,115 patients with type 2 diabetes initiating antidiabetic drugs between January 2007 and September 2015. Adjusted hazard ratios (HRs) and 95% CIs of incident diabetic retinopathy were estimated using time-dependent Cox proportional hazards models, comparing use of GLP-1 RAs with current use of two or more oral antidiabetic drugs. In an ancillary analysis, new users of GLP-1 RAs were compared with new users of insulin.

RESULTS
During 245,825 person-years of follow-up, 10,763 patients were newly diagnosed with diabetic retinopathy. Compared with current use of two or more oral antidiabetic drugs, use of GLP-1 RAs was not associated with an increased risk of incident diabetic retinopathy overall (HR 1.00, 95% CI 0.85-1.17). Compared with insulin, GLP-1 RAs were associated with a decreased risk of diabetic retinopathy (HR 0.67, 95% CI 0.51-0.90).

CONCLUSIONS
The associations with diabetic retinopathy varied according to the type of comparator. When compared with use of two or more oral antidiabetic drugs, use of GLP-1 RAs was not associated with an increased risk of incident diabetic retinopathy. The apparent lower risk of diabetic retinopathy associated with GLP-1 RAs compared with insulin may be due to residual confounding.



AUTHOR(S)

Antonios Douros, Kristian B Filion, Hui Yin, Oriana Hoi Yu, Mahyar Etminan, Jacob A Udell, Laurent Azoulay,

JOURNAL

Diabetes care

PLACE

United States