Your patient asks you why...what will you say?
Recent advances in diabetes management have introduced powerful new treatments, including GLP-1 receptor agonists like semaglutide and SGLT2 inhibitors such as empagliflozin.
While these novel agents offer improved glycemic control and additional benefits like weight loss and cardiovascular protection, concerns have emerged regarding potential risks of diabetic retinopathy progression, particularly with rapid glucose lowering.
Studies like SUSTAIN-6 reported increased rates of retinopathy complications with semaglutide compared to placebo, similar to the worsening of diabetic retinopathy observed in the DCCT study with intensive insulin therapy. However, the long-term benefits of improved glycemic control likely outweigh short-term retinal risks for most patients.
To mitigate potential vision threats, we need to consider comprehensive retinal evaluations before initiating any potent glucose-lowering therapy, especially in patients with pre-existing retinopathy or poor baseline glycemic control. Implementing accessible point-of-care retinal imaging, potentially aided by artificial intelligence, could also facilitate widespread screening and allow general physicians to identify high-risk individuals requiring an ophthalmic referral and evaluation prior to treatment.
-JRM
Go to the article in Retina:
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