Study Finds GLP-1 RA Use for Diabetes & Weight Loss Reduces the Risk of Sight-Threatening Diabetic Retinopathy

GLP-1 Use May Help Preserve Vision in People with Diabetes

While injectable medications for type 2 diabetes were linked to a few additional cases of early diabetic eye disease, there was less progression to stages involving vision loss.

Burlington, MA – Investigators from Lahey Hospital & Medical Center (LHMC) report that a popular class of injectable medications for type 2 diabetes (T2D) and weight loss may be safer than first reported and help to protect vision. In a study published in JAMA Network Open, the physician-scientists comprehensively assessed how these increasingly widely prescribed drugs may affect the eyes of people with T2D. While previous studies suggested that this class of medications raised the risk of diabetic eye complications, the new study offers a detailed look at both early and advanced stages of diabetic eye disease across a large, real-world population of patients treated with GLP-1 RAs, medications that mimic a natural hormone to help lower blood sugar, promote weight loss, and support heart health in people with type 2 diabetes or obesity.

“To our knowledge, the findings of this study provide some of the first evidence that, among individuals with T2D, the use of GLP-1 RAs was associated with a much lower risk of sight-threatening complications,” said corresponding author Sarju Ganatra, MD, vice chair for research in the Department of Medicine and director of the Cardio-Oncology Program at LHMC. “While GLP-1 RAs may slightly raise the risk of developing early signs of diabetic eye disease, they may also offer protection against some of the most severe vision-related complications.”

Using a national health database covering the years 2015 to 2022, Ganatra and colleagues analyzed data from more than 185,000 adults with T2D. After carefully matching patients by age, sex, and other health characteristics, the investigators compared those who were prescribed GLP-1 RAs with demographically similar patients who were not.

Over a two-year follow-up period, patients who received GLP-1 RAs had a less than one percent increased risk of developing new onset diabetic retinopathy. However, more importantly, among a subgroup of more than 32,000 patients who had preexisting diabetic eye disease, fewer went on to experience sight-threatening complications, including vision loss, after starting GLP-1 RAs.

Moreover, the use of GLP-1 RAs was associated with a nearly 30 percent reduction in the risk of diabetic retinopathy resulting in vision loss.

Diabetic retinopathy is a common complication of diabetes, affecting more than 100 million people worldwide, and the leading cause of vision loss in working-age adults. It occurs when chronically high blood sugar levels damage the tiny blood vessels in the retina, the light-sensitive tissue at the back of the eye. When caught early, diabetic retinopathy can be managed with lifestyle changes and medications. At later stages, costly laser therapy or injections are needed to help prevent progression to vision-threatening stages.

“Improving blood sugar levels is a key factor in delaying the progression of diabetic retinopathy and preventing sight-threatening complications,” said lead author David J. Ramsey, MD, PhD, MPH, director of ophthalmic research in the Division of Ophthalmology at LHMC. “Because GLP-1 RAs work by keeping blood sugar under tight control, our findings illustrate how these medications may also support better long-term eye health in people with diabetes.”

The investigators suggest that GLP-1 RAs may offer a cost-effective strategy for preventing serious eye complications in people with diabetic retinopathy. Patients who received GLP-1 prescriptions were less likely to require costly interventions for later-stage diabetic retinopathy — such as eye injections, laser therapy, and anti-VEGF therapy — potentially reducing the burden on both patients and the healthcare system. Still, the real-world effectiveness of these drugs hinges on patient adherence; currently, the average patient discontinues using GLP-1 RAs after nine months, often because of loss of insurance coverage.

“Our study adds to the growing body of evidence that GLP-1 drugs may not only improve blood sugar control and reduce cardiovascular risk, but also help preserve vision in people with diabetes,” said Ganatra.

“As we weigh the costs of these medications, it is also important to consider their potential to reduce the need for expensive and invasive treatments for diabetic eye disease,” added Ramsey.

Co-authors included Bhargav Makwana, MD; Sourbha S Dani, MD, MSc; Manav Patel, MD; Krisha Panchal, MD; Jui Shah, MD; Sumanth Khadke, MD; and Tirth Patel, MD, of LHMC; Ashish Kumar, MD, of Mayo Clinic; Michael N. Kosiborod, MD, of Saint Luke’s Mid America Heart Institute and the University of Missouri; Gregg C. Fonarow, MD, of Ronald Reagan UCLA Medical Center; Kathryn Moynihan Ramsey, PhD, of Northwestern University Feinberg School of Medicine; Anju Nohria, MD, of Brigham and Women's Hospital; and Javed Butler, MD, MPH, MBA, of Baylor Scott & White Research Institute and University of Mississippi.

Ramsey reported receiving consulting fees from Regeneron Pharmaceuticals and Beaver-Visitec International, Inc. outside the submitted work. Please see JAMA Network Open for a complete list of disclosures.

About Lahey Hospital & Medical Center

Lahey Hospital & Medical Center (LHMC) is a world-renowned tertiary academic medical center known for its innovative technology, pioneering medical treatments and leading-edge research. As a physician-led hospital, LHMC offers a legacy of care and education committed to putting the patient at the center through a multidisciplinary, collaborative and team-based approach. LHMC’s research efforts and clinical trials cross numerous medical disciplines, providing patients with access to the latest options in treatment and care.

LHMC is a part of Beth Israel Lahey Health, a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.