SGLT2 Inhibitors Showed No Effect on Mean CST in Eyes with DME

Blake Cooper, MD, MPH

Credit: Retina Associates

New research indicates the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors showed no effect on mean central subfield thickness (CST) in eyes with diabetic macular edema (DME).¹

The results, presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA 2023), additionally revealed that SGLT2 inhibitors had no effect on the risk of needing intravitreal treatment for DME.

“Currently, there is limited literature on the impact SGLT2 inhibitors have on diabetes-related retinopathy and more specifically DME,” wrote the investigative team, led by Blake Cooper, MD, MPH, Retina Consultants of America.

SGLT2 inhibitors have shown systemic benefits for those with type 2 diabetes (T2D), beyond glycemic reductions. Evidence from large cardiovascular outcome trials suggests SGLT2 inhibitors improve cardiovascular and renal outcomes. Recent years have seen SGLT2 inhibitors become the standard of care to prevent diabetes-related kidney disease and slow its progression.²

The objective of the current study was to evaluate the effect of SGLT2 inhibitors on CST and treatment interval for those with DME.¹ The retrospective matched cohort study with propensity score matching evaluated 1000 consecutive people with diabetes. Covariates included age, sex, type of diabetes, level of retinopathy, insurance, intravitreal injection status, and visual acuity.

The primary outcome of the analysis was CST on optical coherence tomography (OCT). Secondary outcomes included intravitreal injections and the frequency of intravitreal injections for macular edema treatment. Of the 1000 people with diabetes, 689 failed to meet the study inclusion criteria, leaving a total of 321 people with diabetes-related retinopathy.

In this population, 280 people had T2D, and 41 people had T1D. Of the 280 people with T2D, 71 were receiving SGLT2 inhibitor treatment and 209 were used for propensity score matching. The mean age of patients was 62.2 years and 165 (58.9%) were Male, while 5 (1.8%) were Asian, 19 (6.8%) were Hispanic/Latino, 31 (11.1%) were Black, and 213 (76.1%) were White. Other patient characteristics showed 37 (13.2%) were smokers, 211 (75.4%) had hypertension, and the mean last HbA1c was 7.6.

In the treatment group, the mean CST OD was 280.1 and the mean CST OS was 280.3; in comparison, for the control group, the mean CST OD was 279.9 and the mean CST OS was 279.4. In the treatment group, 29 patients (40.8%) received intravitreal injections, compared to 77 patients (36.8%) in the control group.

Upon analysis, comparing CST and the need for intravitreal injection to those not on an SGLT2 inhibitor, investigators found no difference in mean CST. The analysis showed those who required intravitreal injections had a risk ratio (RR) of 1.13 and a risk difference (RD) of 0.03 (95% CI, -0.07 to 0.14; P = .55). After propensity score matching, the study revealed the ATE risk difference was 0.04 (95% CI, -0.05 to 0.14; P = .37).

“SGLT2 inhibitor use had no effect on mean CST or the risk of needing intravitreal treatment for DME,” the investigative team wrote.

References

1. Stevens H, Breen JM, Cooper B. Causal Effect of SGLT2 Inhibition on diabetes-related macular edema. Poster presentation at the 83rd Scientific Sessions of the American Diabetes Association. June 23 – 26, 2023.
2. Minze MG, Will KJ, Terrell BT, Black RL, Irons BK. Benefits of SGLT2 Inhibitors Beyond Glycemic Control - A Focus on Metabolic, Cardiovascular and Renal Outcomes. Curr Diabetes Rev. 2018;14(6):509-517. doi:10.2174/1573399813666170816142351