Periocular surgery risk after glucagon-like peptide-1 receptor agonist therapy for type 2 diabetes

Purpose To evaluate the association between GLP-1RA therapy and the hazard of involutional periocular surgical procedures among patients with type 2 diabetes.Methods This retrospective cohort study used the TriNetX electronic health record database. Adults aged 45 years and older with type 2 diabetes were included. A GLP-1RA cohort was created with evidence of continued therapy defined by a second prescription at least 1 year after initiation. The comparison cohort included patients prescribed other antidiabetic medications, excluding GLP-1RAs. Propensity score matching balanced demographics, comorbidities, and insulin use. The primary outcomes were the hazards of periocular surgery during four nonoverlapping 9-month intervals (0–9, 9–18, 18–27, and 27–36 months) and cumulatively over 0–36 months.Results GLP-1RA use was associated with a higher hazard of upper eyelid blepharoplasty (HR range: 1.988–2.788), blepharoptosis repair (HR range: 1.322–1.813), and brow ptosis repair (HR range: 1.683–2.393) compared with other antidiabetic medications (all p ≤ 0.028). Elevated hazard occurred within 0–9 months of treatment and generally increased through 18–27 months.Conclusions GLP-1RA therapy was associated with an increased hazard of involutional periocular surgical procedures compared with other antidiabetic medications, suggesting a potential association between GLP-1RA use and periocular soft tissue changes.