(A-307) The Effectiveness on Diabetic Retinopathy Between GLP-1 Receptor Agonists and DPP-4 Inhibitors in Taiwan

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective in managing type 2 diabetes, offering benefits such as glycemic control and cardiovascular protection. However, their potential role in preventing specific complications, particularly diabetic retinopathy, remains unclear due to conflicting evidence, with some studies indicating potential risks while others showing no increased risk.

Objectives: To compare the risk between diabetic retinopathy and the use of GLP-1RAs versus DPP4 inhibitors in the type 2 diabetes population in Taiwan.

Methods: We conducted a nationwide cohort study using real-world data to assess and clarify the association between GLP-1RAs and the prevention of diabetic retinopathy. This retrospective cohort study addressed potential confounders using propensity score matching, pairing controls for each case with ratios of 1:1 and 1:4. Individuals enrolled in Taiwan's National Health Insurance Research Database (NHIRD) from 2016 to 2021 were included. The index date was defined as the first prescription date of GLP-1RAs or DPP4 inhibitors. Patients who initiated both medications simultaneously, used the opposite medication within three years prior to the index date, or had a record of diabetic retinopathy within three years before the index date were excluded. The outcome of interest was diabetic retinopathy. An intention-to-treat design was applied, with follow-up defined from the index date to the occurrence of the outcome, death, or the end of the study period (December 31, 2022), whichever came first. Hazard ratios were estimated using the Cox proportional hazards model.

Results: We identified 9,120 cases of GLP-1RAs and 699,252 cases of DPP4 inhibitors. For diabetic retinopathy, the hazard ratios were 0.94 (95% CI:0.85-1.05) for 1:1 matching and 0.97 (95% CI: 0.90-1.04) for 1:4 matching.

Conclusions: Our findings suggest that the preventive effect of GLP-1RAs on diabetic retinopathy is comparable to that of DPP4 inhibitors, indicating no significant difference in effectiveness regarding diabetic retinopathy. We suggest that clinicians choose suitable agents based on other clinical and reimbursement considerations.