The association between the use of sodium glucose cotransporter 2 inhibitor and the risk of diabetic retinopathy and other eye disorders: a systematic review and meta-analysis

Ma, Yunke; Lin, Chu; Cai, Xiaoling; Hu, Suiyuan; Zhu, Xiaoxi; Lv, Fang; Yang, Wenjia; Ji, Linong

doi:10.1080/17512433.2022.2102973

Cited by 18 publications

(10 citation statements)

References 55 publications

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“…SGLT2 inhibitors were also compared with GLP-1 RAs in a multi-institutional retrospective cohort study in type 2 DM patients in Taiwan and a lower risk of DME was demonstrated for the SGLT-2 inhibitors arm [ 83 ]. A recent meta-analysis of randomized controlled trials designed to determine correlation between SGLT-2 inhibitors and the incidence of DR proved a significant reduction of DR risk in patients treated with SGLT-2 inhibitors with diabetes duration of less than 10 years, which confers its potential value in early treatment initiation [ 84 ]. Corresponding results were obtained in a meta-analysis of randomized controlled trials, in which ertugliflozin and empagliflozin reduced the risk of DR in patients with type 2 DM [ 85 ].…”

Section: Resultsmentioning

confidence: 99%

Will GLP-1 Analogues and SGLT-2 Inhibitors Become New Game Changers for Diabetic Retinopathy?

Wołos-Kłosowicz

Matuszewski

Rutkowska

et al. 2022

JCM

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Diabetic retinopathy (DR) is the most frequent microvascular complication of diabetes mellitus (DM), estimated to affect approximately one-third of the diabetic population, and the most common cause of preventable vision loss. The available treatment options focus on the late stages of this complication, while in the early stages there is no dedicated treatment besides optimizing blood pressure, lipid and glycemic control; DR is still lacking effective preventive methods. glucagon-like peptide 1 receptor agonists (GLP-1 Ras) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors have a proven effect in reducing risk factors of DR and numerous experimental and animal studies have strongly established its retinoprotective potential. Both drug groups have the evident potential to become a new therapeutic option for the prevention and treatment of diabetic retinopathy and there is an urgent need for further comprehensive clinical trials to verify whether these findings are translatable to humans.

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Section: Resultsmentioning

confidence: 99%

Will GLP-1 Analogues and SGLT-2 Inhibitors Become New Game Changers for Diabetic Retinopathy?

Wołos-Kłosowicz

Matuszewski

Rutkowska

et al. 2022

JCM

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“…The post hoc analysis of the EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose) trial found that empagliflozin was not associated with a significant difference in the risk of vision-threatening retinopathy compared with placebo . Three meta-analyses of randomized clinical trials also found that SGLT2i treatment was not associated with ocular events compared with no SGLT2i treatment . However, a meta-analysis found that SGLT2i was associated with a reduced risk of diabetic retinopathy in patients with diabetes for less than 10 years .…”

Section: Discussionmentioning

confidence: 99%

“… 20 Three meta-analyses of randomized clinical trials also found that SGLT2i treatment was not associated with ocular events compared with no SGLT2i treatment. 21 , 22 , 23 However, a meta-analysis found that SGLT2i was associated with a reduced risk of diabetic retinopathy in patients with diabetes for less than 10 years. 22 Another meta-analysis reported that ertugliflozin and empagliflozin could reduce the risk of retinal disease, whereas canagliflozin could increase the risk of vitreous disease.…”

Section: Discussionmentioning

confidence: 99%

“… 21 , 22 , 23 However, a meta-analysis found that SGLT2i was associated with a reduced risk of diabetic retinopathy in patients with diabetes for less than 10 years. 22 Another meta-analysis reported that ertugliflozin and empagliflozin could reduce the risk of retinal disease, whereas canagliflozin could increase the risk of vitreous disease. 23 The association of SGLT2i with decreased central retinal thickness and improved diabetic macular edema has been reported in several case reports.…”

Section: Discussionmentioning

confidence: 99%

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Sodium-Glucose Cotransporter 2 Inhibitors and Risk of Retinopathy in Patients With Type 2 Diabetes

Yen,

Wei,

et al. 2023

JAMA Netw Open

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ImportanceDiabetic nephropathy and diabetic retinopathy share many similarities in pathophysiological processes. Preclinical studies have shown that sodium-glucose cotransporter 2 inhibitors (SGLT2is) have a protective role in the risk of diabetic retinopathy.ObjectiveTo compare the risk of sight-threatening retinopathy associated with SGLT2is and other second-line glucose-lowering medications (including pioglitazone, sulfonylureas, and dipeptidyl peptidase-4 inhibitors [DPP-4is]) in patients with type 2 diabetes (T2D).Design, Setting, and ParticipantsThis cohort study in Taiwan applied a new-user and active-comparator design. Patient demographic and clinical data were obtained from the National Health Insurance Research Database. Adult patients with newly diagnosed T2D from January 1, 2009, to December 31, 2019, were recruited and followed up until December 31, 2020. Propensity score matching was used to identify pairs of patients treated with SGLT2i vs DPP-4i, SGLT2i vs pioglitazone, and SGLT2i vs sulfonylurea from January 1, 2016, to December 31, 2019. Data were analyzed between August 18, 2022, and May 5, 2023.ExposuresTreatment with SGLT2i, DPP-4i, pioglitazone, and sulfonylureas starting on January 1, 2016.Main Outcomes and MeasuresThe main outcome was sight-threatening retinopathy in participants. Cox proportional hazards regression models were used to assess relative hazards of sight-threatening retinopathy between the matched case and control groups.ResultsA total of 3 544 383 patients with newly diagnosed T2D were identified. After 1:1 propensity score matching, 65 930 pairs of patients treated with SGLT2i vs DPP-4i, 93 760 pairs treated with SGLT2i vs pioglitazone, and 42 121 pairs treated with SGLT2i vs sulfonylurea were identified. These matched patients included 236 574 males (58.6%), with a mean (SD) age of 56.9 (11.8) years. In the matched cohorts, SGLT2i had a significantly lower risk of sight-threatening retinopathy than DPP-4i (adjusted hazard ratio [AHR], 0.57; 95% CI, 0.51-0.63), pioglitazone (AHR, 0.75; 95% CI, 0.69-0.81), and sulfonylureas (AHR, 0.62; 95% CI, 0.53-0.71). The Kaplan-Meier curves showed that SGLT2i was associated with a significantly lower cumulative incidence of sight-threatening retinopathy than DPP-4i (3.52 vs 6.13; P &lt; .001), pioglitazone (4.32 vs 5.76; P &lt; .001), and sulfonylureas (2.94 vs 4.67; P &lt; .001).Conclusions and RelevanceThis cohort study found that SGLT2i was associated with a lower risk of sight-threatening retinopathy compared with DPP-4i, pioglitazone, and sulfonylureas. This finding suggests that SGLT2i may play a role not only in reduced risk of diabetic nephropathy but also in the slow progression of diabetic retinopathy in patients with T2D.

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“…Some studies have evaluated the influence of SGLT2 inhibitors on ophthalmic diseases [12,13]. Development and progression of diabetic retinopathy could be suppressed by the application of SGLT2 inhibitors in some previous research but without a universal consensus [14][15][16][17][18]. It has also been reported that the incidence of dry eye disease could be reduced via use of SGLT2 inhibitors [19,20].…”

Section: Introductionmentioning

confidence: 99%

The use of sodium-glucose cotransporter 2 inhibitors and the incidence of uveitis in type 2 diabetes: a population-based cohort study

Chung,

Yang,

Chang

et al. 2024

Arch Med Sci

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IntroductionTo survey the potential correlation between the application of sodium-glucose cotransporter 2 (SGLT2) inhibitors and the incidence of uveitis in individuals with type 2 diabetes mellitus (T2DM).Material and methodsA retrospective cohort study using the National Health Insurance Research Database (NHIRD) was conducted. The T2DM patients using SGLT2 inhibitors and those taking other anti-diabetic medications were assigned to the SGLT2 group and the control group, respectively, with a 1 : 2 ratio via the propensity score-matching (PSM) method. The major outcome in this study is the development of uveitis according to the diagnostic codes. The Cox proportional hazard regression was adopted to yield the adjusted hazard ratio (aHR) with 95% confidence interval (CI) between the groups.ResultsThere were 147 and 371 new uveitis episodes in the SGLT2 and control groups after the follow-up period up to 5 years. The incidence of uveitis in the SGLT2 group (aHR = 0.736, 95% CI: 0.602–0.899, p = 0.0007) was significantly lower than that in the control group after adjusting for the effect of all the confounders. In the subgroup analyses, the SGLT2 inhibitors showed a higher correlation with low uveitis incidence in T2DM patients aged under 50 than T2DM individuals aged over 50 years (p = 0.0012), while the effect of SGLT2 inhibitors on the incidence of anterior and posterior uveitis development was similar (p = 0.7993).ConclusionsThe use of SGLT2 inhibitors could be an independent protective factor for uveitis development in T2DM population.

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The association between the use of sodium glucose cotransporter 2 inhibitor and the risk of diabetic retinopathy and other eye disorders: a systematic review and meta-analysis

Cited by 18 publications

References 55 publications

Will GLP-1 Analogues and SGLT-2 Inhibitors Become New Game Changers for Diabetic Retinopathy?

Will GLP-1 Analogues and SGLT-2 Inhibitors Become New Game Changers for Diabetic Retinopathy?

Sodium-Glucose Cotransporter 2 Inhibitors and Risk of Retinopathy in Patients With Type 2 Diabetes

The use of sodium-glucose cotransporter 2 inhibitors and the incidence of uveitis in type 2 diabetes: a population-based cohort study

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