GLP-1RA use linked to 19% reduction in risk for glaucoma in type 2 diabetes
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Key takeaways:
- GLP-1RA use was associated with a 19% reduction in risk for glaucoma in patients with type 2 diabetes.
- Long-term use reduced the risk for glaucoma even more.
Use of glucagon-like peptide-1 receptor agonists was associated with a 19% reduction in risk for glaucoma in patients with type 2 diabetes, with longer use extending the protective association, according to a study in Ophthalmology.
“Glucagon-like peptide-1 receptor agonists (GLP-1RAs), commonly prescribed for the management of type 2 diabetes and obesity, recently have gained attention for their role in facilitating retinal neuroprotection, which may prevent glaucoma development and progression,” Siar Niazi, MD, of the department of cardiology at North Zealand Hospital in Denmark, and colleagues wrote.
They continued, “We aimed to investigate the risk of glaucoma development in individuals with type 2 diabetes, comparing the use of GLP-1RA with other antihyperglycemic medications, using Danish nationwide registries.”
In a nested case-control study, the researchers used the National Prescription Registry to identify 264,708 individuals with type 2 diabetes, aged older than 21 years, who had initiated first-line treatment with metformin as well as second-line antihyperglycemic therapy. Of those, 1,737 individuals had incident glaucoma and were matched with 8,685 glaucoma-free controls (median age, 70 years; 44.6% women).
Prevalence of hypertension was similar between groups, but the glaucoma cases had a slightly shorter duration of type 2 diabetes than controls.
According to results, GLP-1RA use was associated with a 19% reduction in glaucoma risk, with use beyond 3 years extending the risk reduction to 29% (P = .007). Conversely, short-term (0-1 year) and medium-term (1-3 years) use did not yield statistically significant risk reduction.
“Our data indicate that GLP-1RA, a second-line anti-hyperglycemic medication, might be a potential adjunctive therapy to IOP-reducing eye drops in managing glaucoma,” Niazi and colleagues wrote. “The observed lower risk of developing glaucoma among individuals with type 2 diabetes on GLP-1RA warrants further investigation to establish if there is an effect beyond improved glycemic control.”
Perspective
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With increased usage, we slowly learn more about the secondary effects of these medications, including possibly facilitating retinal neuroprotection and an anti-inflammatory effect. The notion is that GLP-1RAs have been shown to slow retinal ganglion cell death and may reduce risk for developing glaucoma in people with diabetes vs. other antihyperglycemic medications.
Though promising, we must consider whether this is a true effect of the medication or are we simply better controlling the diabetes such that these patients are not developing diabetic retinopathy, which we know can result in retinal ischemia and lead to the eventual development of glaucoma.
The role of this study in clinical practice is the awareness of our patient’s complete medical history. Without a doubt, we are going to see patients who are on these medications and either have glaucoma or suspected to have glaucoma. Continued and longitudinal research will show whether this protective effect is maintained over the long term.
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