Study Finds SGLT-2 Inhibitor May Slow Progression of Diabetic Retinopathy in Patients with Type 2 Diabetes

Empagliflozin was associated with a 22 percent lower risk of progression from early stages of diabetic retinopathy to more advanced stages in this patient group

Diabetic retinopathy (DR) affects about 26 percent of people with diabetes. While many patients have an early form of DR, the condition can progress, posing the threat of irreversible vision loss. Empagliflozin is a sodium-glucose contratransporter-2 inhibitor (SGLT-2), an oral medication that helps patients with type 2 diabetes control their glucose levels. A research team led by investigators from Mass General Brigham conducted a cohort study comparing treatment with empagliflozin to another form of diabetes treatment for patients with type 2 diabetes. They found that while empagliflozin did not reduce risk of DR in patients with no history of that disease, among patients who had early-stage DR, the medication was associated with a decreased risk of progression. Results are published in JAMA Ophthalmology.

“Our findings showed that in patients with type 2 diabetes and non-proliferative diabetic retinopathy, empagliflozin could be beneficial in slowing down progression to more advanced stages of diabetic retinopathy,” said lead author Helen Tesfaye, PharmD, MSc, of the Division of Pharmacoepidemiology at Brigham and Women’s Hospital. “Our findings could help inform clinical decision making for patients with diabetes who have non-proliferative diabetic retinopathy or are at risk for developing DR.”

The study represents a collaboration across Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH), both founding members of the Mass General Brigham healthcare system, with experts from BWH’s Division of Renal (Kidney) Medicine and MGH’s Diabetes Center working with Tesfaye and colleagues from the Division of Pharmacoepidemiology.

“Leveraging the clinical and analytical expertise of our multidisciplinary team allows us to identify risk and benefits of diabetes medications that are not being studied—or may not be apparent—in clinical trials,” said Deborah Wexler, MD, MSc, Chief of the MGH Diabetes Unit and Associate Professor of Medicine at Harvard Medical School.

The research team conducted their study by looking at nationwide insurance claims data from August 2014 to September 2019 for adults with type 2 diabetes who initiated one of two drugs—either empagliflozin or a dipeptidyl peptidase 4 inhibitor (DPP4i), another type of oral medication for type 2 diabetes. Researchers looked at outcomes for more than 34,000 pairs of patients taking one of the two medications. While they found no difference in rates of new cases of diabetic retinopathy, they found that risk of DR progression was lower among patients taking empagliflozin (158 cases of progression) compared to those taking the other medication (201 cases).

The authors note that diabetic retinopathy can take years to develop. Patients in the study were followed for a mean of eight months—a relatively short period of time—and future studies will be needed to understand the longer term relationship between empagliflozin and risk of DR progression or onset.

Authorship: In addition to Tesfaye and Wexler, Mass General Brigham authors include Julie M. Paik, Phyo T. Htoo, Heidi Zakoul, and Elisabetta Patorno. Additional authors include Miin Roh, Niklas Schmedt, and Lisette Koeneman.

Disclosures: Tesfaye, Zakoul, and Paik have no conflicts of interest to disclose. Patorno was supported by research grants from the Patient Centered Outcomes Research Institute (DB-2020C2-20326) and the Food and Drug Administration (5U01FD007213), not related to the topic of this work. Wexler served on Data Monitoring Committees for studies evaluating a GLP-1 receptor for Novo Nordisk. Koeneman is an employee of Eli Lilly and Company and owns stock in Eli Lilly and Company. Schmedt is an employee of Boehringer-Ingelheim.

Funding: Boehringer Ingelheim (116283).

Paper cited: Tesfaye H et al. “Empagliflozin and the Risk of Retinopathy in Patients With Type 2 Diabetes” JAMA Ophthalmology DOI: 10.1001/jamaophthalmol.2024.5219