Glaucoma is a leading cause of irreversible vision loss worldwide, and type 2 diabetes mellitus (T2DM) is increasingly recognized as a risk factor for glaucoma. This study compared the effects of 3 classes of antidiabetic drugs—sodium–glucose cotransporter 2 inhibitors (SGLT‐2is), glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), and dipeptidyl peptidase 4 inhibitors (DPP‐4is)—on ocular and systemic complications in adults with T2DM. Using the TriNetX database from 2015 to 2025, adults aged ≥ 40 years initiating SGLT‐2is, GLP‐1 RAs, or DPP‐4is were identified and matched through propensity score methods to create three cohorts. The primary outcomes included open‐angle glaucoma and ocular hypertension, with secondary outcomes of cataract, diabetic retinopathy, macular edema, and various systemic events. The matched cohorts included 68,283 patients (SGLT‐2is vs. GLP‐1 RAs), 69,765 patients (SGLT‐2is vs. DPP‐4is), and 55,760 patients (GLP‐1 RAs vs. DPP‐4is). Compared with GLP‐1 RAs and DPP‐4is, SGLT‐2i use was associated with significantly lower risks of open‐angle glaucoma (HR: 0.88 and 0.90), ocular hypertension (HR: 0.78 and 0.90), cataract (HR: 0.84 and 0.87), diabetic retinopathy (HR: 0.84 and 0.87), and macular edema (HR: 0.77 and 0.71). Conversely, GLP‐1 RAs demonstrated stronger protective effects against systemic complications, such as diabetic nephropathy or chronic kidney disease, liver cirrhosis, dementia, cerebral infarction, and ischemic heart disease. These findings suggest that SGLT‐2is may be prioritized in T2DM patients at higher risk for ocular complications, while GLP‐1 RAs may be preferred when systemic risk reduction is the primary therapeutic goal.
Lin et al. (2025) studied this question.