OBJECTIVE: Previous studies suggested that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may initially worsen and possibly increase the risk of diabetic retinopathy. However, data on this possible association remain limited. Thus, this population-based study aimed to determine whether use of GLP-1 RAs is associated with an increased risk of incident diabetic retinopathy.
RESEARCH DESIGN AND METHODS: Using the U.K. Clinical Practice Research Datalink, we conducted a cohort study among 77,115 patients with type 2 diabetes initiating antidiabetic drugs between January 2007 and September 2015. Adjusted hazard ratios (HRs) and 95% CIs of incident diabetic retinopathy were estimated using time-dependent Cox proportional hazards models, comparing use of GLP-1 RAs with current use of two or more oral antidiabetic drugs. In an ancillary analysis, new users of GLP-1 RAs were compared with new users of insulin.
RESULTS: During 245,825 person-years of follow-up, 10,763 patients were newly diagnosed with diabetic retinopathy. Compared with current use of two or more oral antidiabetic drugs, use of GLP-1 RAs was not associated with an increased risk of incident diabetic retinopathy overall (HR 1.00, 95% CI 0.85-1.17). Compared with insulin, GLP-1 RAs were associated with a decreased risk of diabetic retinopathy (HR 0.67, 95% CI 0.51-0.90).
CONCLUSIONS: The associations with diabetic retinopathy varied according to the type of comparator. When compared with use of two or more oral antidiabetic drugs, use of GLP-1 RAs was not associated with an increased risk of incident diabetic retinopathy. The apparent lower risk of diabetic retinopathy associated with GLP-1 RAs compared with insulin may be due to residual confounding.
|投稿者||Douros, Antonios; Filion, Kristian B; Yin, Hui; Yu, Oriana Hoi; Etminan, Mahyar; Udell, Jacob A; Azoulay, Laurent|
|組織名||Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, Quebec, Canada.;Department of Epidemiology, Biostatistics, and Occupational Health, McGill;University, Montreal, Quebec, Canada.;Institute of Clinical Pharmacology and Toxicology, Charite-Universitatsmedizin;Berlin, Berlin, Germany.;Division of Clinical Epidemiology, Department of Medicine, McGill University,;Division of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada.;Department of Ophthalmology and Visual Sciences, University of British Columbia,;Vancouver, British Columbia, Canada.;Women's College Research Institute and Cardiovascular Division, Department of;Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario,;Canada.;Cardiovascular Division, Department of Medicine, Peter Munk Cardiac Centre,;Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.;Montreal, Quebec, Canada email@example.com.;Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec,|