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Incretin-Based Therapies and Diabetic Retinopathy: Real-World Evidence in Older U.S. Adults.
- Source :
-
Diabetes care [Diabetes Care] 2018 Sep; Vol. 41 (9), pp. 1998-2009. Date of Electronic Publication: 2018 Jul 16. - Publication Year :
- 2018
-
Abstract
- Objective: Recent large trials yield conflicting results on the association between incretin-based therapies (IBTs) and diabetic retinopathy (DR). We examined whether IBTs increase DR risk compared with other antihyperglycemics.<br />Research Design and Methods: We implemented an active comparator, new-user cohort design using a nationwide 20% random sample of fee-for-service U.S. Medicare beneficiaries aged 65 years or older with Parts A, B, and D coverage between 2007 and 2015. We identified the following cohorts without prior treatment for retinopathy: dipeptidyl peptidase 4 inhibitors (DPP4i) versus sulfonylureas (SU), DPP4i versus thiazolidinediones (TZD), glucagon-like peptide-1 receptor agonists (GLP1RA) versus long-acting insulin (LAI), and GLP1RA versus TZD. Primary outcome was advanced diabetic retinopathy requiring treatment (ADRRT), defined as a procedure code for retinopathy treatment. Incident diabetic retinopathy (IDR), identified by a diagnosis code, was a secondary outcome. We estimated propensity scores to balance confounders and adjusted hazard ratios (95% CI) using weighted Cox proportional hazards models.<br />Results: We identified 213,652 eligible patients. During a median duration of 0.58 to 0.87 years across comparisons, with a rate from 6.0 to 12.8 per 1,000 person-years, IBTs were not associated with increased ADRRT or IDR risk. The adjusted hazard ratios (95% CI) for ADRRT were 0.91 (0.79-1.04) by comparing DPP4i to SU ( n = 39,292 and 87,073); 0.91 (0.75-1.11), DPP4i to TZD ( n = 51,410 and 22,231); 0.50 (0.39-0.65), GLP1RA to LAI ( n = 9,561 and 82,849); and 0.75 (0.53-1.06), GLP1RA to TZD ( n = 10,355 and 27,345).<br />Conclusions: Our population-based cohort study of older U.S. adults with diabetes suggests that IBTs used for approximately 1 year do not increase the DR risk.<br /> (© 2018 by the American Diabetes Association.)
- Subjects :
- Aged
Aged, 80 and over
Cohort Studies
Diabetic Retinopathy etiology
Dipeptidyl-Peptidase IV Inhibitors administration & dosage
Dipeptidyl-Peptidase IV Inhibitors adverse effects
Drug Therapy, Combination
Female
Humans
Hypoglycemic Agents adverse effects
Incretins adverse effects
Insulin, Long-Acting therapeutic use
Male
Risk Factors
Sulfonylurea Compounds therapeutic use
Thiazolidinediones therapeutic use
United States epidemiology
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 drug therapy
Diabetes Mellitus, Type 2 epidemiology
Diabetic Retinopathy epidemiology
Hypoglycemic Agents administration & dosage
Incretins administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1935-5548
- Volume :
- 41
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Diabetes care
- Publication Type :
- Academic Journal
- Accession number :
- 30012674
- Full Text :
- https://doi.org/10.2337/dc17-2285