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

• Published in: PloS one Vol. 14; no. 10; p. e0224549
• Main Authors: Chung, Yoo-Ri, Ha, Kyoung Hwa, Lee, Kihwang, Kim, Dae Jung
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.10.2019; Public Library of Science (PLoS)
• Subjects: Aged; Analysis; Aspirin; Biology and life sciences; Blood pressure; Clinical trials; Codes; Cohort analysis; Cohort Studies; Complications; Dapagliflozin; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetic retinopathy; Diabetic Retinopathy - drug therapy; Diabetic Retinopathy - pathology; Diabetics; Dipeptidyl-peptidase IV; Dipeptidyl-Peptidase IV Inhibitors - pharmacology; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Disease Progression; Endocrinology; Female; Glucose; Health; Health hazards; Hemoglobin; Humans; Inhibitors; Initiators; Insurance; Male; Medical research; Medical screening; Medicine; Medicine and Health Sciences; Metabolic disorders; Middle Aged; National health insurance; Peptidase; Regression analysis; Regression models; Republic of Korea; Research and Analysis Methods; Retinopathy; Retrospective Studies; Risk; Social Sciences; Sodium; Sodium-glucose cotransporter; Sodium-Glucose Transporter 2 Inhibitors - pharmacology; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Studies; Systematic review; Type 2 diabetes; Weight loss; Republic of Korea; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0224549

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.