New anti-hyperglycaemic agents for type 2 diabetes and their effects on diabetic retinopathy

Abstract

There has been an increase in the range of non-insulin anti-hyperglycaemic agents used to treat type 2 diabetes. With the globally rising rates of type 2 diabetes and complications such as diabetic retinopathy, it is important for ophthalmologists to be aware of these new agents and their impacts on diabetic retinopathy and diabetic macular oedema. We conducted a review of the literature to determine if there were any beneficial or harmful effects of the currently used anti-hyperglycaemic agents on diabetic retinopathy or diabetic macular oedema. Our review of the current literature found that apart from thiazolidinediones, anti-hyperglycaemic agents have been reported to have beneficial or neutral effects on diabetic eye complications. Thiazolidinediones (pioglitazone is the only one currently available) have been linked to incident or worsening diabetic macular oedema, although the rate is believed to be low. Glucagon-like peptide 1 (GLP1) agonists (incretins) in general are beneficial except semaglutide which is associated with increased rates of diabetic retinopathy complications. These results have implications for selection of anti-hyperglycaemic agents for patients with diabetic retinopathy or macular oedema. Further studies need to be conducted to identify if reported beneficial effects are independent of the impact of glycaemic control. Early worsening of retinopathy with tight glycaemic control should also be noted in interpretation of future studies.

Subpopulation Differences in the Cardiovascular Efficacy of Long-Acting Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

“…A recent study reported that the elevated risk of retinopathy was largely dependent on the baseline presence of pre-existing retinopathy, and that the occurrence of retinopathy primarily resulted from the magnitude and rapidity of glycemic reduction [27]. Furthermore, several previous studies reported no association between GLP-1R agonists and diabetic retinopathy [28][29][30], which is in agreement with the results of the current study.…”

Sirtuin (Sirt) 3 Overexpression Prevents Retinopathy in Streptozotocin-Induced Diabetic Rats

“…Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus. The main features of diabetic retinopathy are the occlusion and retinal hard exudates of retinal microvessels, which lead to blindness in severe cases [ 1 ]. Metabolic abnormalities caused by persistent hyperglycemia is the main pathogenesis of diabetic retinopathy, which can damage retinal microvascular system, including changes of capillary permeability, destruction of blood-retinal barrier, retinal leakage, macular edema, retinal vitreous hemorrhage, neovascularization, and retinal detachment [ 2 ].…”

Diabetic Retinopathy In Patients With Type 2 Diabetes: Aspects Of Early Diagnosis, Treatment And Prediction Of The Outcome Of The Disease

“…The detection . Given the global increase in the incidence of type 2 diabetes and complications such as DR, ophthalmologists need to know about these new agents and their effect on diabetic retinopathy and diabetic macular oedema, according to a multicenter study in Australia [40].…”