GLP-1 RAs closely associated with increased risk of developing incident diabetic retinopathy: JAMA
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A new study published in the Journal of American Medical Association found that the use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) was linked to a little rise in incident diabetic retinopathy (DR), while fewer individuals needed invasive treatments, incurred problems from DR, or saw their DR escalate to sight-threatening levels.
A higher incidence of diabetic retinopathy and nonarteritic anterior ischemic optic neuropathy (NAION) is linked to GLP-1 RAs. There is little research on the possibility of sight-threatening effects linked to GLP-1 RAs. Thus, this study was set to find out if using GLP-1 RAs in T2D patients is linked to the emergence of DR, NAION, or DR sequelae.
Using the TriNetX database, this retrospective cohort analysis was carried out from January 1, 2015, to September 30, 2022, on persons (≥18 years old) with T2D who had a recent hemoglobin A1c level of 6.5% or above. Using propensity score matching (PSM) to account for baseline characteristics, the cohort was split into 2 groups according to whether or not the participants were prescribed a GLP-1 RA. On October 10, 2024, the statistical analysis was carried out. The primary endpoint, the relationship between GLP-1 RAs and the probability of incident DR, NAION, or sight-threatening sequelae over a 2-year follow-up period, was assessed using Cox proportional hazard regression models.
Following PSM, GLP-1 receptor agonists were administered to 185,066 people (mean [SD] age, 59.0 [12.5] years; 93,389 females [50.5%]). A higher incidence of DR was linked to the use of GLP-1 RAs (hazard ratio [HR], 1.07; 95% CI, 1.03-1.11), although there was no statistically significant difference in the risk of NAION (HR, 1.26; 95% CI, 0.94-1.70).
In a subgroup analysis of 32 695 patients with preexisting DR, GLP-1 RAs were linked to a lower incidence of vitreous hemorrhages (HR, 0.74; 95% CI, 0.68-0.80), neovascular glaucoma (HR, 0.78; 95% CI, 0.68-0.88), or blindness (HR, 0.77; 95% CI, 0.73-0.82), but not to the development of proliferative DR (HR, 1.06; 95% CI, 0.97-1.15) or diabetic macular edema (HR, 0.98; 95% CI, 0.95-1.01).
Overall, GLP-1 RA use was linked to a slightly higher risk of incident DR in this cohort study of people with T2D; even among those who already had DR, fewer patients developed sight-threatening DR complications, such as blindness. These results imply that all T2D patients using GLP-1 RAs, irrespective of DR history, have to undergo routine screening and follow-up to identify any possible T2D problems.
Source:
Ramsey, D. J., Makwana, B., Dani, S. S., Patel, M., Panchal, K., Shah, J., Khadke, S., Kumar, A., Patel, T., Kosiborod, M. N., Fonarow, G. C., Ramsey, K. M., Nohria, A., Butler, J., & Ganatra, S. (2025). GLP-1 receptor agonists and sight-threatening ophthalmic complications in patients with type 2 diabetes. JAMA Network Open, 8(8), e2526321. https://doi.org/10.1001/jamanetworkopen.2025.26321
