SGLT2 inhibitors and diabetic retinopathy progression: evidence from a retrospective cohort study and Mendelian randomization analysis - Summary - MDSpire
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SGLT2 inhibitors and diabetic retinopathy progression: evidence from a retrospective cohort study and Mendelian randomization analysis
To investigate the association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) use and diabetic retinopathy (DR) progression, and to explore supporting genetic and molecular evidence.
Approach:
Study Design: Retrospective cohort study at Shandong Provincial Hospital from January 2023 to December 2024.
Participants: Patients with type 2 diabetes on stable SGLT2i plus basal insulin or sulfonylureas plus basal insulin.
Assessment Method: Wide-field swept-source optical coherence tomography angiography (SS-OCTA) was used to assess retinal microvascular parameters.
Statistical Analysis: Kaplan–Meier and Cox regression analyses evaluated DR progression; Mendelian randomization and mediation analyses were conducted.
Key Findings:
SGLT2i+INS was associated with a lower risk of DR progression (HR = 0.40, 95% CI 0.19–0.84; P = 0.016).
Reduced cumulative incidence of DR was observed in the SGLT2i+INS group (log-rank P = 0.032).
Mendelian randomization supported an association between genetically proxied SGLT2 and DR risk (OR = 1.21, 95% CI 1.05–1.39; P = 0.009).
Nine metabolites and five plasma proteins showed nominal evidence of potential mediation.
Interpretation:
SGLT2i use was associated with a lower risk of DR progression compared to sulfonylurea use in insulin-treated patients with type 2 diabetes.
Limitations:
Retrospective design may introduce bias.
Findings require validation in larger prospective studies and randomized trials.
Conclusion:
SGLT2i may provide exploratory prognostic and biological insights regarding DR progression.
