Use of SGLT2 inhibitors reduces risk of dry eye disease: JAMA

TAIWAN: According to the researchers of a large retrospective study reported in JAMA Network Open, one advantage of SGLT2 inhibitors in people with type 2 diabetes (T2D) may be a decreased risk of dry eye illness compared to recipients of GLP-1 RAs. 

According to the International Diabetes Federation, there were 463 million people with diabetes worldwide in 2019, and an estimated of 700 million by 2045. Dry eye disease (DED) is one of the most often observed symptoms associated with type 2 diabetes, despite the fact that diabetic retinopathy is a well-known ocular consequence brought on by persistent hyperglycemia (T2D). The majority of current clinical trials and observational studies concentrate on the relationship between the use of SGLT2 inhibitors and mortality and macrovascular and microvascular problems in T2D patients. There isn't enough proof in the literature to support the claim that SGLT2 inhibitors affect DED.

"The selection of SGLT2 inhibitors for women with T2D or individuals with worse renal function should be dependent on other therapeutic considerations as there were no discernible changes in DED risks between SGLT2 inhibitor and GLP-1 receptor agonist use in these populations at high risk of DED," the authors said.

Therefore, the objective of the current study was to assess the risk of DED following the administration of SGLT2 inhibitors to T2D patients.

For this purpose, retrospective data analysis was done on 10,038 T2D patients who got SGLT2 inhibitors and 5,608 who received GLP-1 receptor agonists from Taiwan's biggest multi-institutional database. The mean age was about 59 and about half of the population was female. Clinical traits like renal function and glucose regulation were comparable between the two groups. According to the International Classification of Diseases classifications and prescriptions for drugs used to treat the condition, the main outcome was the incidence of dry eye disease. The primary result was examined in relation to the kind of diabetic medication, numerous clinical variables, and Cox proportional hazards regression models.

Conclusive points:

• As compared to those using GLP-1 RAs (11.5 occurrences per 1000 person-years), patients newly taking SGLT2 inhibitors had a decreased incidence of DED, which resulted in a hazard ratio of 0.78 (95% CI, 0.68-0.89).
• According to subgroup analyses, patients with T2D who used SGLT2 inhibitors had lower DED chances than those who did not, regardless of their age, sex, blood sugar level, or kidney function.
• Results from the sensitivity analysis, which used propensity score matching, on-treatment analyses, and various follow-up intervals of 1, 2, and 3 years, were consistent with those from the primary analyses.
• Due to systemic factors like lower testosterone levels and a higher prevalence of autoimmune illnesses, women may be more susceptible than men to develop dry eye disease.
• As a result of tear hyperosmolarity and increased ocular surface inflammation, individuals with renal impairment or proteinuria may be more susceptible to the syndrome.

"Our results with the small absolute risk difference between SGLT2 inhibitors and GLP-1 RAs [receptor agonists] (2.5 per 1,000 person-years) could serve as an important reference for clinical decisions about prescribing various anti-diabetic drugs to delay or prevent DED in individuals with T2D," the authors wrote.

The researchers came to the conclusion that DED risk may be lower in newly prescribed SGLT2 inhibitors for T2D patients than in newly prescribed GLP-1 RAs. To examine these results, prospective studies are required, they added.

REFERENCE

Su Y, Hung J, Chang K, et al. 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. JAMA Netw Open. 2022;5(9):e2232584. doi:10.1001/jamanetworkopen.2022.32584