Effects of sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic retinopathy and its progression: A real-world Korean study.

Yoo-Ri Chung,Dae Jung Kim,Kyoung Hwa Ha,Kihwang Lee,Ping-Hsun Wu

doi:10.1371/journal.pone.0224549

Yoo-Ri Chung, Dae Jung Kim + Show 3 more

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https://doi.org/10.1371/journal.pone.0224549

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Journal: PloS one	Publication Date: Oct 28, 2019
Citations: 26	License type: CC BY 4.0

Affiliation: Ajou University

Abstract

The sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce the incidence of macrovascular complications of diabetes, while their effect on diabetic retinopathy has not been clarified. We compared the effects of SGLT2is with those of dipeptidyl peptidase-4 inhibitors (DPP4is) on the risk of diabetic retinopathy and its progression in people with type 2 diabetes. We performed a retrospective cohort study among people with type 2 diabetes who started on a SGLT2i or DPP4i from 2014 to 2016 according to the Korean National Health Insurance Service database. Subjects initiated on a SGLT2i or DPP4i were matched on a 1:1 basis according to their propensity scores, and Cox proportional hazards regression models were used to calculate the hazard ratios for the risk of diabetic retinopathy and its progression. After propensity score-matching, 41,430 patients without a history of diabetic retinopathy were identified as new users of a SGLT2i (n = 20,175) or DPP4i (n = 20,175). The hazard ratio (95% CI) for diabetic retinopathy was 0.89 (0.83–0.97) for SGLT2i initiators compared with DPP4i initiators. In patients with a history of diabetic retinopathy (n = 4,663 pairs), there was no significant difference in diabetic retinopathy progression between SGLT2i initiators and DPP4i initiators (hazard ratio 0.94, 95% CI 0.78–1.13). This real-world cohort study showed that SGLT2is might be associated with lower risk of diabetic retinopathy compared with DPP4is. Randomized controlled trials are needed to investigate the long-term effect of SGLT2is in diabetic retinopathy in people with diabetes.

Highlights

The sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a newly introduced class of antihyperglycemic agents that lower the blood glucose level by reducing glucose reabsorption in the renal proximal tubule [1]
In cohort 2, subjects initiating a sodium-glucose cotransporter-2 inhibitor https (SGLT2i) were younger, more frequently female, and had a higher mean body mass index (BMI) than those starting on a dipeptidyl peptidase-4 inhibitor (DPP4i); the mean fasting glucose levels were similar (S2 Table)
In subgroup analyses stratified by confounding factors, SGLT2i initiators had a lower risk of diabetic retinopathy (DR) than DPP4i initiators, especially in those with a history of cardiovascular diseases, those treated with low-dose acetylsalicylic acid (ASA), those with fasting glucose < 126 mg/dL, and those systolic blood pressure < 140 mmHg (Fig 3)

Summary

Introduction

The sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a newly introduced class of antihyperglycemic agents that lower the blood glucose level by reducing glucose reabsorption in the renal proximal tubule [1]. They induce weight loss and lower blood pressure; these effects have led to multiple randomized controlled trials of their influence on cardiovascular outcomes [2,3,4]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

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