Empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, has shown promise in slowing the progression of diabetic retinopathy (DR) in patients with type 2 diabetes. A new study from Mass General Brigham indicates that empagliflozin is associated with a 22 percent reduction in the risk of progression from early to more advanced stages of DR in this patient population.
The research, published in JAMA Ophthalmology, offers insights into managing diabetic retinopathy, which affects approximately 26 percent of individuals with diabetes. While many patients initially present with a mild form of DR, the condition can worsen, leading to potential irreversible vision loss. Empagliflozin, an oral medication, aids in controlling glucose levels in type 2 diabetes patients.
Study Details and Findings
The research team, led by Helen Tesfaye, PharmD, MSc, from Brigham and Women’s Hospital, conducted a cohort study comparing empagliflozin treatment to dipeptidyl peptidase 4 inhibitors (DPP4i). The study leveraged nationwide insurance claims data from August 2014 to September 2019, analyzing over 34,000 pairs of patients initiating either empagliflozin or a DPP4i.
While the study found no significant difference in the rates of new DR cases between the two treatment groups, it revealed a notable reduction in the risk of DR progression among patients taking empagliflozin. Specifically, 158 cases of DR progression were observed in the empagliflozin group compared to 201 cases in the DPP4i group.
"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 Tesfaye. "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."
Implications and Future Research
The study's authors noted that the relatively short follow-up period (mean of eight months) necessitates further research to understand the long-term effects of empagliflozin on DR progression and onset. Longer-term studies are crucial to validate these findings and explore the sustained impact of empagliflozin on diabetic retinopathy.
"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.
