Abstract 4144717: SGLT2 Inhibitors and Diabetic Retinopathy: Reducing Surgical Interventions and Vision Loss

Background: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors extend their utility beyond glycemic control in type 2 diabetes mellitus (T2DM) by demonstrating cardiovascular risk reduction, heart failure protection, and attenuation of chronic kidney disease progression. Additionally, SGLT-2 inhibitors may confer ancillary benefits in reducing the risk of diabetic retinopathy (DR). This study evaluates the impact of SGLT2 inhibitors on DR outcomes in a matched cohort of T2DM patients. Methods: Utilizing data from the US Collaborative Network, we assessed the effects of SGLT2 inhibitors on DR in 97,495 propensity score-matched pairs using the TriNetX analytics platform. Comparative analyses between treated and untreated cohorts were conducted, including risk differences, odds ratios (OR), risk ratios (RR), and p-values. Evaluated outcomes encompassed surgical interventions requiring laser photocoagulation, anti-VEGF injection utilization, and incidence of vision loss. Results: In terms of surgical interventions (retinal excision and repair, and vitreous drainage), the SGLT2 inhibitor cohort exhibited a significant risk reduction, evidenced by a risk difference of -0.000 (95% CI: -0.001 to -0.000, p=0.027), RR of 0.790 (95% CI: 0.640 to 0.974), and OR of 0.789 (95% CI: 0.640 to 0.974). No significant difference was observed for laser photocoagulation (Risk Difference: 0.000, 95% CI: -0.000 to 0.000, p=1.000). Similarly, anti-VEGF injection outcomes did not differ significantly despite a risk difference of -0.002 (95% CI: -0.003 to -0.001, p=0.002). The analysis revealed a substantial protective effect against vision loss in the SGLT2-treated patients, with a risk difference of -0.010 (95% CI: -0.012 to -0.008, p<0.000), RR of 0.793 (95% CI: 0.759 to 0.829), and OR of 0.785 (95% CI: 0.750 to 0.822). Conclusion: Our findings indicate that SGLT2 inhibitors significantly decrease the necessity for surgical interventions and the risk of vision loss in patients with DR. The lack of significant differences in laser photocoagulation and anti-VEGF injection outcomes suggests targeted benefits of SGLT2 inhibitors. These results underscore the potential role of SGLT2 inhibitors as a valuable component in the management strategy for diabetic retinopathy.