Objective:

To evaluate and compare the risk signals, clinical characteristics, and potential influencing factors of visual impairment adverse events associated with insulin degludec, insulin detemir, and insulin glargine, highlighting the importance of these findings in diabetes management.

Key Findings:

• Insulin glargine showed the strongest association with visual impairment (ROR = 3.60, 95% CI: 3.54–3.67), while insulin degludec had the weakest (ROR = 1.59, 95% CI: 1.47–1.72).
• Insulin degludec and detemir were primarily linked to diabetic retinopathy; insulin glargine was strongly associated with diabetic glaucoma (ROR = 50.36, 95% CI: 50.00–50.72).
• Over 60% of visual impairment reports involved female patients, and 93% were from the U.S.
• Higher body weight may be a protective factor against visual impairment.
• Weibull analysis indicated an early-onset pattern for visual impairment across all insulins.

Interpretation:

The study highlights significant differences in the risk of visual impairment AEs among long-acting insulins, suggesting the need for tailored ophthalmic monitoring in diabetic patients starting basal insulin therapy, with implications for clinical practice.

Limitations:

• Inability to differentiate between Type 1 and Type 2 diabetes characteristics in the FAERS database, which may affect the generalizability of findings.
• Potential confounding factors in multivariate regression analysis that could influence results.

Conclusion:

Long-acting insulins are associated with varying risks of visual impairment AEs, necessitating individualized monitoring during the initiation of therapy, and highlighting the need for further research in this area.