Diabetes and the Retina: The Role of Medical Treatment

Summary About 20% of people with diabetes worldwide have diabetic retinopathy (DR); nearly 25% will have DR in 2045. DR and vision impairment are associated with atherosclerotic cardiovascular disease (ASCVD), dementia, and mortality. DR tracks with hyperglycemia, and intensive glycemic treatment improves DR, although its ultimate effect in reducing visual impairment is less clear. But rapid falls from high to more normal HbA1c are associated with worsening DR. BP treatment to systolic levels in the low to mid 140 mmHg range is associated with a reduction in DR, but there is some evidence that systolic levels in the low to mid 120 mmHg range are associated with vision loss. A number of classes of medications used for ASCVD improve DR, including inhibitors of the Renin‐Angiotensin‐Aldosterone System (RASi), fenofibrate, and the sodium‐glucose transport (SGLT)‐2 inhibitors. It is uncertain whether the glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) are associated with improvement or worsening in DR. This may be particularly true with the more potent agents in this class, perhaps so in the context of rapid and large reductions in HbA1c.