Association of GLP1 ‐Receptor Agonists With Diabetic Retinopathy

Aim We aimed to examine the association between glucagon‐like peptide‐1 receptor agonists (GLP1‐RA) use and diabetic retinopathy and non‐arteritic anterior ischemic optic neuropathy (NAION), using dipeptidyl peptidase‐4 inhibitors (DPP4i) as active comparators. Methods We created a retrospective propensity score (PS)‐matched cohort study of patients who initiated either GLP1‐RA or DPP4i (years 2006–2021). Using new‐users, we created two PS‐matched cohorts: patients with diabetes (overall cohort) and patients with diabetes and chronic kidney disease (CKD‐cohort); the latter represents patients at higher likelihood of diabetes microvascular complications. Primary outcomes were non‐vision‐threatening diabetic retinopathy (NVTDR), vision‐threatening diabetic retinopathy and diabetic macular edema (VTDR/DME), and NAION. Secondary outcomes included vision impairment or blindness and occurrence of retinopathy procedures. Results PS‐matched overall cohort included 98 082 pairs of GLP1‐RA or DPP4i users. GLP1‐RA users had higher risk of NVTDR (11.05% vs. 9.98%; odds ratio [OR] 1.12, 95% confidence interval [95% CI]: 1.09–1.15), VTDR/DME (2.17% vs. 1.98%; OR 1.09, 95% CI: 1.03–1.16), and occurrence of retinopathy procedures (4.16% vs. 3.68%, OR 1.14, 95% CI: 1.09–1.19). There was no significant difference in risk of NAION (OR 1.11, 95% CI: 0.96–1.29) or vision impairment or blindness (OR 1.04, 95% CI: 0.97–1.11). In the CKD cohort (15 440 matched pairs), GLP1‐RA was associated with high risk of NVTDR (OR 1.10, 95% CI: 1.03–1.18), and occurrence of retinopathy procedures (OR 1.14, 95% CI: 1.03–1.26), but not other outcomes. Conclusions GLP1‐RA use was associated with a modest increase in risk of diabetic retinopathy and retinopathy‐related procedures, independent of the presence of retinopathy at baseline. However, GLP1‐RA use was not associated with vision impairment or blindness, although administrative codes notably have low validity for blindness diagnosis.