Impact of GLP-1 Agonists and SGLT-2 Inhibitors on Diabetic Retinopathy Progression: An Aggregated Electronic Health Record Data Study

Wai, Karen M.; Mishra, Kapil; Koo, Euna; Ludwig, Cassie Ann; Parikh, Ravi; Mruthyunjaya, Prithvi; Rahimy, Ehsan

doi:10.1016/j.ajo.2024.04.010

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Related to vision, patients with diabetic retinopathy who received semaglutide incurred a higher risk of exacerbation of the retinopathy, especially with rapid reduction in hemoglobin A 1c levels, 22 and a higher rate of progression of proliferative retinopathy and risk of newonset macular edema. 23 There has been no prior mention, to our knowledge, of an increased risk of NAION in association with semaglutide, and our study does not inform a mechanism to link semaglutide to NAION. Despite evidence of neuroprotective properties, 24,25 expression of the GLP-1 receptor in the human optic nerve 26 and GLP-1 RA-induced enhanced sympathetic nervous system activity might influence optic nerve head perfusion and potentially increase the risk of NAION.…”

Section: Discussionmentioning

confidence: 57%

“…As with any drug, however, therapeutic benefits are inseparable from adverse effects. Related to vision, patients with diabetic retinopathy who received semaglutide incurred a higher risk of exacerbation of the retinopathy, especially with rapid reduction in hemoglobin A 1c levels, and a higher rate of progression of proliferative retinopathy and risk of new-onset macular edema . There has been no prior mention, to our knowledge, of an increased risk of NAION in association with semaglutide, and our study does not inform a mechanism to link semaglutide to NAION.…”

Section: Discussionmentioning

confidence: 63%

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Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide

Hathaway,

Shah,

Hathaway

et al. 2024

JAMA Ophthalmol

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ImportanceAnecdotal experience raised the possibility that semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) with rapidly increasing use, is associated with nonarteritic anterior ischemic optic neuropathy (NAION).ObjectiveTo investigate whether there is an association between semaglutide and risk of NAION.Design, Setting, and ParticipantsIn a retrospective matched cohort study using data from a centralized data registry of patients evaluated by neuro-ophthalmologists at 1 academic institution from December 1, 2017, through November 30, 2023, a search for International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code H47.01 (ischemic optic neuropathy) and text search yielded 16 827 patients with no history of NAION. Propensity matching was used to assess whether prescribed semaglutide was associated with NAION in patients with type 2 diabetes (T2D) or overweight/obesity, in each case accounting for covarying factors (sex, age, systemic hypertension, T2D, obstructive sleep apnea, obesity, hyperlipidemia, and coronary artery disease) and contraindications for use of semaglutide. The cumulative incidence of NAION was determined with the Kaplan-Meier method and a Cox proportional hazards regression model adjusted for potential confounding comorbidities. Data were analyzed from December 1, 2017, through November 30, 2023.ExposuresPrescriptions for semaglutide vs non–GLP-1 RA medications to manage either T2D or weight.Main Outcomes and MeasuresCumulative incidence and hazard ratio of NAION.ResultsAmong 16 827 patients, 710 had T2D (194 prescribed semaglutide; 516 prescribed non–GLP-1 RA antidiabetic medications; median [IQR] age, 59 [49-68] years; 369 [52%] female) and 979 were overweight or obese (361 prescribed semaglutide; 618 prescribed non–GLP-1 RA weight-loss medications; median [IQR] age, 47 [32-59] years; 708 [72%] female). In the population with T2D, 17 NAION events occurred in patients prescribed semaglutide vs 6 in the non–GLP-1 RA antidiabetes cohort. The cumulative incidence of NAION for the semaglutide and non–GLP-1 RA cohorts over 36 months was 8.9% (95% CI, 4.5%-13.1%) and 1.8% (95% CI, 0%-3.5%), respectively. A Cox proportional hazards regression model showed higher risk of NAION for patients receiving semaglutide (hazard ratio [HR], 4.28; 95% CI, 1.62-11.29); P &lt; .001). In the population of patients who were overweight or obese, 20 NAION events occurred in the prescribed semaglutide cohort vs 3 in the non–GLP-1 RA cohort. The cumulative incidence of NAION for the semaglutide vs non–GLP-1 RA cohorts over 36 months was 6.7% (95% CI, 3.6%-9.7%) and 0.8% (95% CI, 0%-1.8%), respectively. A Cox proportional hazards regression model showed a higher risk of NAION for patients prescribed semaglutide (HR, 7.64; 95% CI, 2.21-26.36; P &lt; .001).Conclusions and RelevanceThis study’s findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 63%

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide

Hathaway,

Shah,

Hathaway

et al. 2024

JAMA Ophthalmol

View full text Add to dashboard Cite

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“…Individuals with serious gastrointestinal conditions such as Gastroparesis and inflammatory bowel disease should also avoid GLP-1 analogs. Very recently, it has been reported that monotherapy with GLP-1 is associated with a risk of new-onset nonproliferative diabetic retinopathy, Diabetic retinopathy, and diabetic macular edema [56,57].…”

Section: Discussionmentioning

confidence: 99%

A Brief Review of Incretin Mimetics Intended for the Management of Diabetes and Associated Comorbidities

Haider,

Imam,

Tulp

et al. 2024

Preprint

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Incretin mimetics, also known as glucagon-like peptide-1 (GLP-1) receptor agonists, are a class of medications used to treat type 2 diabetes by mimicking the actions of incretin hormones in the body. These hormones are responsible for promoting insulin release from the pancreas in response to nutrient intake, as well as decreasing glucagon secretion, slowing gastric emptying, and promoting satiety. By imitating these actions, incretin mimetics help to regulate blood sugar levels in individuals with diabetes and glucose intolerance. One of the key benefits of incretin mimetics is its ability to lower blood sugar levels without causing hypoglycemia. This is especially important for individuals with diabetes who may experience dangerous drops in blood sugar levels when using other medications. Additionally, incretin mimetics have been shown to promote weight loss in some individuals, making them a valuable option for those struggling with obesity in addition to diabetes. Incretin mimetics are administered by injection, once or twice daily, depending on the specific medication. They are often combined with other diabetes medications, such as metformin or insulin, for optimal blood sugar control. These medications are generally well-tolerated, with common side effects including nausea, vomiting, and diarrhea, which usually diminish over time as the body adjusts to the medication. Studies have shown that incretin mimetics can help improve cardiovascular outcomes in individuals with diabetes, including reducing the risk of heart attacks and strokes. This is particularly significant given the increased risk of cardiovascular disease in individuals with diabetes. Incretin mimetics also have been shown to preserve pancreatic beta-cell function, which is responsible for producing insulin. This can help slow the progression of diabetes and reduce the need for higher insulin doses over time. Despite their many benefits, incretin mimetics are not without limitations. They can be expensive compared to other diabetes medications, which may make them less accessible for some individuals. Additionally, there have been concerns about the potential risk of pancreatitis and pancreatic cancer associated with the use of these medications. However, more research is needed to fully understand these risks. It is important for healthcare providers to carefully assess each individual's unique needs and medical history when considering the use of incretin mimetics. They may not be appropriate for everyone, particularly those with a history of pancreatitis or pancreatic cancer. Patients should also be educated about these medications' proper administration and potential side effects to ensure their safety and efficacy. Overall, incretin mimetics have emerged as an important therapeutic option for individuals with type 2 diabetes, offering a unique mechanism of action that can help improve blood sugar control, promote weight loss, and reduce cardiovascular risk. With ongoing research and development in this field, incretin mimetics continue to show promise as valuable tools in managing diabetes and its associated complications and comorbidities.

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GLP-1-Rezeptoragonisten: Im Spannungsfeld zwischen Vorsicht und Alarm

Ziemssen,

Hammes,

Helbig

2024

Klin Monbl Augenheilkd

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Impact of GLP-1 Agonists and SGLT-2 Inhibitors on Diabetic Retinopathy Progression: An Aggregated Electronic Health Record Data Study

Cited by 5 publications

References 28 publications

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide

A Brief Review of Incretin Mimetics Intended for the Management of Diabetes and Associated Comorbidities

GLP-1-Rezeptoragonisten: Im Spannungsfeld zwischen Vorsicht und Alarm

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