Background: Diabetic Retinopathy (DR) is a common complication among individuals with type 2 diabetes (T2D) and a leading cause of vision impairment. Recent studies have highlighted the dual effects of GLP-1 receptor agonists (GLP-1 RAs) on DR progression. While these medications offer potential neuroprotective benefits, they may also pose a risk of early worsening in some patients due to the sudden reduction in HbA1c.
Objectives: This study evaluates factors associated with GLP-1 RA utilization in commercially insured DR patients using MarketScan data from 2017–2019.
Methods: This retrospective cohort study analyzed administrative claims from the 2017–2019 MarketScan Commercial database. Adults with a diagnosis of DR (ICD-10: E11.3) who received a GLP-1 RA prescription following a 6-month washout period were identified as users, while non-users were defined as DR patients who did not receive a GLP-1 RA prescription. GLP-1 RA users were matched with non-users at a 1:4 ratio using prescription time distribution matching. Sociodemographic characteristics, comorbidities, and co-medications were compared using Chi-square tests and logistic regression analyses. Analyses were conducted using SAS version 9.4.
Results: Among 74,295 DR patients, 13,683 (18.42%) filled a GLP-1 RA prescription. GLP-1 RA has been used more frequently in female DR patients (OR = 1.46, 95% CI: 1.40–1.53, p< 0.0001), who were younger (ages 35–44 vs. 55-64: OR = 1.31, 95% CI: 1.21–1.41, p< 0.0001; ages 45–54 vs. 55-64: OR = 1.18, 95% CI: 1.12–1.23, p< 0.0001), prescribed insulin (OR = 2.81, 95% CI: 2.69–2.94, p< 0.0001), prescribed two or more oral antidiabetic medications (OR = 19.32, 95% CI: 18.22–20.48, p< 0.0001). While patients with proliferative DR (PDR) were less likely to receive GLP-1 RAs (OR = 0.89, 95% CI: 0.82–0.97, p = 0.0066).
Conclusions: While GLP-1 RA use was more common in patients with advanced diabetes, its lower utilization among those with PDR may reflect cautious prescribing due to concerns about DR severity and the uncertain effects on proliferative retinal conditions. This underscores the need for further research to evaluate the long-term impact of GLP-1 RAs on DR progression and visual outcomes, helping to guide future prescribing practices.
