Key result
Diabetic retinopathy in T2D is linked to complex regimens and ~219% higher diabetic kidney disease prevalence.
Why the study?
The relationship between antidiabetic treatment strategies and diabetic retinopathy in real-world practice remains unclear despite novel glucose-lowering agents and advancements in ophthalmologic care.
How does the diagnosis of diabetic retinopathy affect the complexity and choice of glucose-lowering therapy in patients with type 2 diabetes?
Observational (n=590)
No
How does the diagnosis of diabetic retinopathy affect the complexity and choice of glucose-lowering therapy in patients with type 2 diabetes?
Odds Ratio: 3.19
p-value: p=<0.0001
Real-world data indicate a paradigm shift in the management of type 2 diabetes following a diagnosis of diabetic retinopathy, with increased utilization of GLP-1 receptor agonists and SGLT2 inhibitors.
DR in T2D should not yet alter therapy selection; leaves open independent links to complex regimens and DKD.
Introduction and Objective: Diabetic retinopathy (DR) is the leading microvascular complication of type 2 diabetes (T2D). Novel glucose-lowering agents and advancements in ophthalmologic care have transformed T2D management. However, the relationship between antidiabetic treatment strategies and DR in real-world practice remains unclear. This study examined the link between DR and the complexity of glucose-lowering therapy in patients with T2D, with a focus on treatment modifications before and after DR diagnosis. Methods: This retrospective observational study included adult patients with T2D who were under the care of the Department of Endocrinology, Nutrition, and Metabolic Diseases at IRCCS MultiMedica from 2010 to 2025. Clinical, demographic, and pharmacological data were extracted from electronic medical records. Patients were primarily stratified by DR status, and antidiabetic therapies were categorized by number and drug class. Results: Of the 590 patients included in the study (mean age: 71.6±11.9 years; 53.7% male, T2D duration 14.5±9.4 years), 109 had DR. DR was associated with longer T2D duration, poorer glycemic control, and higher prevalence of diabetic kidney disease (OR 3.19, p< 0.0001) and neuropathy (OR 2.19, p=0.022). Male sex was associated with a significantly higher risk of DR (OR 1.62). Patients with DR more often required complex, multi-drug regimens (p=0.022). Following a DR diagnosis, therapy shifted toward the use of insulin, SGLT2 inhibitors (SGLT2i), and GLP-1 receptor agonists (GLP-1RAs), while metformin and sulfonylureas were used less frequently. Notably, GLP-1RAs became the most common monotherapy (p<0.0001); GLP-1RAs and SGLT2i predominated in multi-drug regimens (p<0.0001). Conclusion: Our real-world data reveal a paradigm shift in DR management, driven by newer glucose-lowering therapies. However, current data on DR are largely the result of older diabetes mellitus treatment interventions. Sex-related differences highlight the need for personalized care. Disclosure P. Senesi: None. A. Ferrulli: None. S. Vujosevic: None. L. Luzi: None. Funding Ricerca Corrente - IRCCS MultiMedica
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Senesi et al. (2026) conducted an observational in Type 2 Diabetes (n=590). Diabetic retinopathy vs. No diabetic retinopathy was evaluated on Diabetic kidney disease (OR 3.19, p=<0.0001). Diabetic retinopathy in patients with type 2 diabetes was associated with a higher need for complex, multi-drug regimens (p=0.022) and a higher prevalence of diabetic kidney disease (OR 3.19).
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