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Do Incretin-Based Therapies Raise Retinopathy Risk?

Diabetes Care; ePub 2018 Jul 16; Wang, Hong, et al

A recent population-based cohort study of older US adults with diabetes suggests that incretin-based therapies (IBTs) used for approximately 1 year do not increase the diabetic retinopathy (DR) risk. Researchers implemented an active comparator, new-user cohort design using a nationwide 20% random sample (n=213,652 eligible) of fee-for-service US Medicare beneficiaries aged ≥65 years with Parts A, B, and D coverage between 2007 and 2015. They identified the following cohorts without prior treatment for retinopathy: dipeptidyl peptidase 4 inhibitors (DPP4i) vs sulfonylureas (SU), DPP4i vs thiazolidinediones (TZD), glucagon-like peptide-1 receptor agonists (GLP1RA) vs long-acting insulin (LAI), and GLP1RA vs TZD. They found:

  • During a median duration of 0.58 to 0.87 years across comparisons, with a rate from 6.0 to 12.8 per 1,000 person-years, IBTs were not associated with increased ADRRT or IDR risk.
  • The adjusted hazard ratios for ADRRT were 0.91 by comparing DPP4i to SU (n=39,292 and 87,073); 0.91 (0.75–1.11), DPP4i to TZD (n=51,410 and 22,231); 0.50 (0.39–0.65), GLP1RA to LAI (n=9,561 and 82,849); and 0.75 (0.53–1.06), GLP1RA to TZD (n=10,355 and 27,345).

Wang T, Hong J-L, Gower EW, et al. Incretin-based therapies and diabetic retinopathy: Real-world evidence in older U.S. adults. [Published online ahead of print July 16, 2018]. Diabetes Care. doi:10.2337/dc17-2285.