Long-term glucose control reduces retinopathy risk. We examine the association between HbA1c change and retinopathy in the first year or at final follow-up in GLP-1 RA cardiovascular outcomes trials (CVOTs). A random-effects model meta-analysis included 6 CVOTs reporting retinopathy events, using within-trial event definitions. Univariate meta-regression analyses describe the association between HbA1c change and retinopathy events. Meta-analysis showed no significant effect of GLP-1 RA on retinopathy risk (odds ratio [OR] 1.10; 95% CI 0.93, 1.30), with moderate heterogeneity between studies (I2=52.2%; Q-statistic p-value=0.063). HbA1c change and retinopathy were significantly associated at 1-year (slope=1.40, p-value=0.002) and overall (Figure), with 0.1% HbA1c reduction associated with 15% increased OR in the first year, declining to 8.0% increase over longer follow-up. In these studies of varying duration (1.3 to 5.4 years), GLP-1 RA treatment was not significantly associated with increased retinopathy risk. HbA1c reduction rate is correlated with risk for retinopathy in people with diabetes and additional CV risk factors. Clinicians should consider retinopathy status when initiating any therapy that rapidly lowers HbA1c.
A. Bethel: Employee; Self; Eli Lilly and Company. R. Diaz: None. N. Castellana: None. H.C. Gerstein: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Consultant; Self; Kowa Pharmaceuticals America, Inc. Research Support; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Sanofi. M. Lakshmanan: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. Stock/Shareholder; Spouse/Partner; Eli Lilly and Company.
Eli Lilly and Company