A large study of people with type 2 diabetes suggests that those who started treatment with a glucagon‑like peptide (GLP)‑1 receptor agonist after diagnosis had slightly increased risk of developing a serious eye condition called ischemic optic neuropathy than people with diabetes treated with other medications.
As reported in the Annals of Internal Medicine, the risk for patients given GLP-1 drugs was about twice that of those given a sodium–glucose cotransporter (SGLT)‑2 inhibitor or a dipeptidyl peptidase (DPP)-4 inhibitor although the absolute risk was still low in all groups.
Ischemic optic neuropathy occurs when the optic nerve sustains damage caused by reduced or blocked blood flow, leading to loss of nerve tissue and vision. The main symptom is sudden, usually painless vision loss in one eye, often with missing areas of the visual field that are frequently permanent. It is a rare condition, with 4-10 cases per 100,000 people per year in the U.S., with some factors like age and conditions like type 2 diabetes increasing risk.
In this study, Chintan Dave, PhD, a researcher at Rutgers University, and colleagues included claims data from 161,489 adults aged 18 to 65 years with type 2 diabetes who were newly prescribed a GLP-1 receptor agonist, 122,114 who started a SGLT‑2 inhibitor, and 86,047 who started a DPP‑4 inhibitor.
They excluded anyone who had previously used these drugs or previously had ischemic optic neuropathy. They approximated randomization by balancing more than 80 characteristics across groups. They then collected follow up data for up to 18 months to see who was later diagnosed with ischemic optic neuropathy.
Over 18 months, about nine out of every 10,000 people in the GLP-1 group were diagnosed with ischemic optic neuropathy, compared with about six out of 10,000 in the GLT‑2 inhibitor group and about four out of 10,000 in the DPP‑4 inhibitor group. Essentially there were three to four extra cases of ischemic optic neuropathy per 10,000 patients in the GLP-1 compared with the other groups.
The researchers note that the apparent excess risk was concentrated in older adults, men, and people with more advanced diabetes or eye or cardiovascular conditions.
GLP-1 receptor agonists are now widely used, both in lower doses for treatment of type 2 diabetes and in higher doses to treat obesity. “Despite the very low absolute risk for ischemic optic neuropathy, the rapidly expanding use of GLP-1 receptor agonists in patients with and without type 2 diabetes increases the clinical and public health importance of any potential association,” conclude the authors.
“Given that type 2 diabetes itself is a risk factor for nonarteritic anterior ischemic optic neuropathy [which constitutes approximately 75% of ischemic optic neuropathy cases] the potential for GLP-1 receptor agonists to further augment this risk has relevant implications for clinical decision making.”
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