GLP-1 receptor agonists and diabetic retinopathy: A meta-analysis of randomized clinical trials

Kapoor, Isha; Sarvepalli, Swara M.; D’Alessio, David A.; Grewal, Dilraj S.; Hadziahmetovic, Majda

doi:10.1016/j.survophthal.2023.07.002

Cited by 16 publications

(4 citation statements)

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“…GLP-1 agonists may accelerate the progression of diabetic retinopathy and can be associated with adverse retinal outcomes while improving glucose control. Although evidence is discordant, data from the literature reported that this effect could be restricted to only some specific analogs and could be related to some background characteristics, such as poor glycemic control, more rapid achievement of glucose targets, higher body weight, and the presence of very high cardiovascular risk [54,55]. The above results align with preclinical evidence suggesting that GLP-1 analogs promote endothelial cell growth and angiogenesis.…”

Section: Dopamine In the Pathogenesis And Treatment Of Traditional Ch...supporting

confidence: 53%

Dopamine in the Regulation of Glucose Homeostasis, Pathogenesis of Type 2 Diabetes, and Chronic Conditions of Impaired Dopamine Activity/Metabolism: Implication for Pathophysiological and Therapeutic Purposes

Lisco,

De Tullio,

Iovino

et al. 2023

Biomedicines

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Dopamine regulates several functions, such as voluntary movements, spatial memory, motivation, sleep, arousal, feeding, immune function, maternal behaviors, and lactation. Less clear is the role of dopamine in the pathophysiology of type 2 diabetes mellitus (T2D) and chronic complications and conditions frequently associated with it. This review summarizes recent evidence on the role of dopamine in regulating insular metabolism and activity, the pathophysiology of traditional chronic complications associated with T2D, the pathophysiological interconnection between T2D and chronic neurological and psychiatric disorders characterized by impaired dopamine activity/metabolism, and therapeutic implications. Reinforcing dopamine signaling is therapeutic in T2D, especially in patients with dopamine-related disorders, such as Parkinson’s and Huntington’s diseases, addictions, and attention-deficit/hyperactivity disorder. On the other hand, although specific trials are probably needed, certain medications approved for T2D (e.g., metformin, pioglitazone, incretin-based therapy, and gliflozins) may have a therapeutic role in such dopamine-related disorders due to anti-inflammatory and anti-oxidative effects, improvement in insulin signaling, neuroinflammation, mitochondrial dysfunction, autophagy, and apoptosis, restoration of striatal dopamine synthesis, and modulation of dopamine signaling associated with reward and hedonic eating. Last, targeting dopamine metabolism could have the potential for diagnostic and therapeutic purposes in chronic diabetes-related complications, such as diabetic retinopathy.

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Section: Dopamine In the Pathogenesis And Treatment Of Traditional Ch...supporting

confidence: 53%

Dopamine in the Regulation of Glucose Homeostasis, Pathogenesis of Type 2 Diabetes, and Chronic Conditions of Impaired Dopamine Activity/Metabolism: Implication for Pathophysiological and Therapeutic Purposes

Lisco,

De Tullio,

Iovino

et al. 2023

Biomedicines

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“… 15 A meta‐analysis of clinical trials of GLP‐1 RAs showed that GLP‐1 RA use was significantly associated with increased risk of early‐stage diabetic retinopathy (RR, 1.31 [95% CI, 1.01–1.68]); however, analysis of individual trials showed that albiglutide was primarily responsible for this trend. 16 A separate meta‐analysis of 6 cardiovascular outcome trials studying GLP‐1 RAs showed no association between GLP‐1 RA treatment and retinopathy (OR, 1.10 [95% CI, 0.93–1.30]). 17 However, there was an association between retinopathy risk and average HbA1c reduction.…”

Section: Diabetes and Ascvdmentioning

confidence: 99%

New Perspectives in Management of Cardiovascular Risk Among People With Diabetes

Gami,

Blumenthal,

McGuire

et al. 2024

JAHA

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Following the publication of results from multiple landmark cardiovascular outcome trials of antihyperglycemic medications over the past 8 years, there has been a major shift in the focus of care for people with type 2 diabetes, from control of hyperglycemia to managing cardiovascular risk. Multiple international cardiology and diabetes society guidelines and recommendations now endorse sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like protein‐1 receptor agonists as first‐line therapies to mitigate cardiovascular risk. The most recent publication is the 2023 European Society of Cardiology guideline on the management of cardiovascular disease in those with type 2 diabetes that, for the first time, recommends use of both classes of medications for the mitigation of cardiovascular risk for those with or at high risk for atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease. Here, we review the evidence behind contemporary society guidelines and recommendations for the management of type 2 diabetes and cardiovascular risk.

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“…Therefore, improvements in blood glucose, blood pressure, and blood lipids may aid in decreasing the occurrence of DR. Meta‐analyses have indicated a significant association between GLP‐1RAs, as compared with a placebo, and the risk of early DR. However, in comparison to insulin, GLP‐1RAs have shown protective effects against advanced DR. 171 A meta‐analysis of CVOT data on GLP‐1RAs has not found a direct association between GLP‐1RAs and DR, but has found a correlation with decreased HbA 1c . 172 Monitoring retinal status, particularly for patients with proliferative DR and/or severe DR, is essential during strict blood glucose management with GLP‐1RAs or other hypoglycemic agents.…”

Section: Chapter 10: Screening and Treatment Of Chronic Complications...mentioning

confidence: 99%

“…The relationship between GLP‐1RAs and DR may be influenced by factors such as the type of agonist, patient sex, age, and disease duration. 171 Data specific to the older diabetic population regarding the association between GLP‐1RAs and DR are currently lacking. Pan‐retinal laser photocoagulation is the major treatment method for proliferative DR, and intravitreous anti‐vascular endothelial growth factor (VEGF) is another effective treatment.…”

Section: Chapter 10: Screening and Treatment Of Chronic Complications...mentioning

confidence: 99%

Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition)

Guo,

Xiao

2024

Aging Medicine

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With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de‐intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full‐cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence‐based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.

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GLP-1 receptor agonists and diabetic retinopathy: A meta-analysis of randomized clinical trials

Cited by 16 publications

References 16 publications

Dopamine in the Regulation of Glucose Homeostasis, Pathogenesis of Type 2 Diabetes, and Chronic Conditions of Impaired Dopamine Activity/Metabolism: Implication for Pathophysiological and Therapeutic Purposes

Dopamine in the Regulation of Glucose Homeostasis, Pathogenesis of Type 2 Diabetes, and Chronic Conditions of Impaired Dopamine Activity/Metabolism: Implication for Pathophysiological and Therapeutic Purposes

New Perspectives in Management of Cardiovascular Risk Among People With Diabetes

Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition)

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