Introduction Glycaemic variability is possibly linked to the development of diabetic retinopathy, and newer second-line glucose-lowering treatments in type 2 diabetes might reduce glycaemic variability. Aim This study aimed to investigate whether newer second-line glucose-lowering treatments are associated with an alternative risk of developing diabetic retinopathy in people with type 2 diabetes. Methods A nationwide cohort of people with type 2 diabetes on second-line glucose-lowering treatment regimens in 2008-2018 was extracted from the Danish National Patient Registry. Adjusted time to diabetic retinopathy was estimated with a Cox Proportional Hazards model. The model was adjusted for age, sex, diabetes duration, alcohol abuse, treatment start year, education, income, history of late-diabetic complications, history of non-fatal major adverse cardiovascular events, history of chronic kidney disease, and history of hypoglycaemic episodes. Results and Discussion Treatment regimens of metformin + basal insulin (HR: 3.15, 95% CI: 2.42-4.10) and metformin + glucagon-like peptide-1 receptor agonist (GLP-1-RA, HR: 1.46, 95% CI: 1.09-1.96) were associated with an increased risk of diabetic retinopathy compared with metformin + dipeptidyl peptidase-4 inhibitors (DPP-4i). Treatment with metformin + sodium-glucose cotransporter-2 inhibitor (SGLT2i, HR: 0.77, 95% CI: 0.28-2.11) was associated with the numerically lowest risk of diabetic retinopathy compared with all regimens investigated. Conclusion Findings from this study indicate that basal insulin and GLP-1-RA are suboptimal second-line choices for people with type 2 diabetes at risk of developing diabetic retinopathy. However, many other considerations concerning the choice of second-line glucose-lowering treatment for type 2 diabetes patients should be taken into account.
Keyphrases
- diabetic retinopathy
- type diabetes
- optical coherence tomography
- chronic kidney disease
- cardiovascular events
- healthcare
- end stage renal disease
- mental health
- glycemic control
- risk factors
- insulin resistance
- rheumatoid arthritis
- emergency department
- physical activity
- blood pressure
- coronary artery disease
- replacement therapy
- adipose tissue
- skeletal muscle
- metabolic syndrome
- interstitial lung disease
- high resolution
- systemic lupus erythematosus
- patient reported outcomes
- peritoneal dialysis