Association between sodium glucose co-transporter 2 inhibitors and incident glaucoma in patients with type 2 diabetes: A multi-institutional cohort study in Taiwan

Shao, Shih‐Chieh; Su, Yangfeng; Lai, Edward Chia‐Cheng; Chang, Kuo‐Chun; Lee, Chaw-Ning; Hung, Ming‐Jui; Lai, Chi-Chun; Huang, Fu-Chin; Hung, Jia‐Horung

doi:10.1016/j.diabet.2022.101318

Cited by 21 publications

(25 citation statements)

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“…Some proposed mechanisms include hyperglycemia-induced increase in intraocular pressure by increasing in aqueous humor in anterior chamber and changing trabecular meshwork function, and diabetes-induced microvascular injury and abnormal vascular regulation of optic nerve head and retina which increase the susceptibility to glaucoma injury ( 63 ). A retrospective cohort study showed a reduced risk of glaucoma in T2DM patients treated with SGLT-2i compared with patients treated with glucagon-like peptide-1 receptor agonist (GLP-1RA) ( 64 ). Due to the limited sample size of this meta-analysis, the data were not enough to compare the incidences of glaucoma between patients treated with SGLT-2i and patients treated with other specific types of hypoglycemic drugs.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between SGLT-2i and Ocular Diseases in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Zeng

Shi

et al. 2022

Front. Endocrinol.

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BackgroundThis meta-analysis was conducted to explore the association between sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and ocular diseases in type 2 diabetes mellitus (T2DM) patients.MethodsPubMed, Cochrane Central Registry of Controlled Trials, Web of Science and Springer were searched for articles on randomized controlled trials (RCTs) involving T2DM patients treated with SGLT-2i versus placebo or other hypoglycemic agents published prior to August 2021. The primary outcome of this meta-analysis was incidence of ocular diseases, which was assessed using risk ratios (RR) and 95% confidence intervals (CI). We reviewed 47 papers and compared the effect of SGLT-2i with the effect of the control groups (placebo and other hypoglycemic drugs) on the incidence of ocular diseases.ResultsCompared with controls, overall SGLT-2i use in T2DM patients was not associated with incidences of cataract, glaucoma, retinal disease and vitreous disease. Ertugliflozin (RR=0.47, P=0.01) reduced the risk for retinal disease, while empagliflozin (RR=0.44, P=0.05) reduced the risk for diabetic retinopathy (DR) compared with controls. SGLT-2i (RR=0.50, P=0.02), perhaps empagliflozin (RR=0.47, P=0.06), reduced the risk of retinal disease compared with active hypoglycemic agents. Canagliflozin (RR=4.50, P=0.03) increased the risk for vitreous disease compared with placebo.ConclusionsThere was no significant correlation between overall SGLT-2i and ocular diseases (cataract, glaucoma, retinal disease, vitreous disease, corneal disease, conjunctival disease, uveal disease, eye haemorrhage and vision problems) in T2DM patients. Ertugliflozin and empagliflozin may protect against ocular diseases, but canagliflozin may promote ocular diseases.

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Section: Discussionmentioning

confidence: 99%

Relationship Between SGLT-2i and Ocular Diseases in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Zeng

Shi

et al. 2022

Front. Endocrinol.

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“…This action could explain the greater DED risk reduction with SGLT2 inhibitors compared with GLP-1 RAs. Together with the positive findings from previous studies related to different ocular inflammatory diseases (eg, diabetic retinopathy, diabetic macular edema, and glaucoma), clinicians may also evaluate the risks for ophthalmologic conditions when selecting antidiabetic medications as intensification therapy to optimize the treatment benefits. Further research should explore the mechanisms of SGLT2 inhibitors in ocular tissues in patients with T2D.…”

Section: Discussionmentioning

confidence: 96%

“… 16 , 17 , 21 , 22 , 23 The data representativeness and the validity of diagnostic codes in the CGRD have also been validated. 15 , 16 , 20 , 24 , 25 , 26 , 27 This study protocol was approved, with waiver of informed consent, by the institutional review board of the Chang Gung Medical Foundation, and we followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline in the reporting of our results.…”

Section: Methodsmentioning

confidence: 99%

“… 13 , 14 Cohort studies in the clinical setting also report beneficial outcomes associated with SGLT2 inhibitors in treatment of ocular inflammatory diseases including diabetic retinopathy, diabetic macular edema, and glaucoma. 15 , 16 , 17 These findings suggest the anti-inflammatory benefits from SGLT2 inhibitor treatment may extend to the retina and the optic nerve head. Because chronic inflammation also plays a major role in the pathophysiologic process of DED, 8 the use of SGLT2 inhibitors could theoretically lower the incidence of DED.…”

Section: Introductionmentioning

confidence: 91%

“…Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a novel drug class with glucose-lowering and other pleiotropic effects for T2D treatment, have been demonstrated to enhance systemic anti-inflammatory effects by increasing fat use, modulating macrophage inflammatory pathways, and inducing low-grade ketonemia, which partially explain the kidney and cardiac protective effects observed in clinical trials . Cohort studies in the clinical setting also report beneficial outcomes associated with SGLT2 inhibitors in treatment of ocular inflammatory diseases including diabetic retinopathy, diabetic macular edema, and glaucoma . These findings suggest the anti-inflammatory benefits from SGLT2 inhibitor treatment may extend to the retina and the optic nerve head.…”

Section: Introductionmentioning

confidence: 97%

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Comparison of Sodium-Glucose Cotransporter 2 Inhibitors vs Glucagonlike Peptide-1 Receptor Agonists and Incidence of Dry Eye Disease in Patients With Type 2 Diabetes in Taiwan

Hung

Chang

et al. 2022

JAMA Netw Open

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ImportanceSodium-glucose cotransporter 2 (SGLT2) inhibitors have been found to improve low-grade systemic and tissue inflammation; however, the association between SGLT2 inhibitor use and the incidence of dry eye disease (DED) has not been explored.ObjectiveTo investigate the association between SGLT2 inhibitor use and dry eye disease in patients with type 2 diabetes (T2D).Design, Setting, and ParticipantsA retrospective cohort analysis of the largest multi-institutional electronic medical records database in Taiwan was conducted to identify patients with T2D newly receiving SGLT2 inhibitors or glucagonlike peptide-1 receptor agonists (GLP-1 RAs) from 2016 to 2018. Data analysis was performed from March 1 to May 31, 2022. Propensity scores with inverse probability of treatment weighting were generated to enable homogeneous comparisons between the 2 groups.ExposuresTreatment with SGLT2 inhibitors or GLP-1 RAs.Main Outcomes and MeasuresIncident dry eye disease, which was defined by clinical diagnoses, plus the related drug prescription. Cox proportional hazards regression models were used to estimate hazard ratios with 95% CIs for the risk of DED.ResultsA total of 10 038 and 1077 T2D patients newly receiving SGLT2 inhibitors (mean [SD] age, 59.5 [12.1] years; 5689 [56.7%] men) or GLP-1 RAs (mean [SD] age, 58.5 [41.2] years; 587 [54.5%] men), respectively, were included in the analysis. The incidence of DED was lower in patients newly receiving SGLT2 inhibitors (9.0 events per 1000 person-years) compared with those receiving GLP-1 RAs (11.5 events per 1000 person-years), yielding a hazard ratio of 0.78 (95% CI, 0.68-0.89). Subgroup analyses indicated that the lowered DED risks associated with SGLT2 inhibitors in patients with T2D were similar across different age, sex, blood glucose level, and kidney function groups. Results from the sensitivity analyses (including the propensity score–matching approach, on-treatment analyses, and different follow-up periods of 1, 2, and 3 years) were similar to the main analyses.Conclusions and RelevanceThe findings of this study suggest that patients with T2D newly receiving SGLT2 inhibitors may have a lower risk for DED compared with those receiving GLP-1 RAs. Prospective studies are needed to analyze these results.

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Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD

Hu,

Shao,

Tsai

et al. 2024

JAMA Netw Open

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ImportanceSodium-glucose cotransporter 2 (SGLT2) inhibitors are associated with lower anemia risk, based on findings from post hoc analyses of the CREDENCE and DAPA-CKD trials; however, the effectiveness of SGLT2 inhibitors in a more generalizable type 2 diabetes (T2D) and chronic kidney disease (CKD) population, with active comparisons pertinent to current practice, is unknown.ObjectiveTo evaluate and compare anemia incidence between SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among patients with T2D and CKD stages 1 to 3.Design, Setting, and ParticipantsThis retrospective cohort study used target trial emulation of an expanded CREDENCE and DAPA-CKD study framework. The study was conducted among adults with T2D and CKD initiating SGLT2 inhibitors or GLP-1 RAs between January 1, 2016, and December 31, 2021, with follow-up until December 31, 2022. The study was conducted at the Chang Gung Medical Foundation, the largest multi-institutional hospital system in Taiwan.ExposuresInitiation of SGLT2 inhibitors or GLP-1 RAs.Main Outcomes and MeasuresThe primary outcome was a composite of anemia outcomes, including anemia event occurrence (hemoglobin level &lt;12-13 g/dL or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes) or anemia treatment initiation. Changes in hematological parameters, including hemoglobin level, hematocrit level, and red blood cell count, were evaluated during the follow-up period for as long as 3 years.ResultsThe cohort included a total of 13 799 patients with T2D and CKD, initiating SGLT2 inhibitors (12 331 patients; mean [SD] age, 62.4 [12.3] years; 7548 [61.2%] male) or GLP-1 RAs (1468 patients; mean [SD] age, 61.5 [13.3] years; 900 [61.3%] male). After the median follow-up period of 2.5 years, patients receiving SGLT2 inhibitors had lower incidence of composite anemia outcomes (hazard ratio [HR], 0.81; 95% CI, 0.73-0.90) compared with those receiving GLP-1 RAs. SGLT2 inhibitors were associated with a lower incidence of anemia events (HR, 0.79; 95% CI, 0.71-0.87) but not with a lower rate of anemia treatment initiation (HR, 0.99; 95% CI, 0.83-1.19). Changes in hematological parameters for SGLT2 inhibitors and GLP-1 RAs throughout the 3-year follow-up period supported the primary analyses.Conclusions and RelevanceIn this multi-institutional cohort study with target trial emulation, SGLT2 inhibitors were associated with a decreased risk of composite anemia outcomes, especially anemia event occurrences. SGLT2 inhibitors may be considered as an adjunct therapy to reduce anemia incidence in patients with T2D and CKD.

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Association between sodium glucose co-transporter 2 inhibitors and incident glaucoma in patients with type 2 diabetes: A multi-institutional cohort study in Taiwan

Cited by 21 publications

References 47 publications

Relationship Between SGLT-2i and Ocular Diseases in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Relationship Between SGLT-2i and Ocular Diseases in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Comparison of Sodium-Glucose Cotransporter 2 Inhibitors vs Glucagonlike Peptide-1 Receptor Agonists and Incidence of Dry Eye Disease in Patients With Type 2 Diabetes in Taiwan

Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD

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