Role of SGLT2 Inhibitors in Diabetic Retinopathy
DOI:
https://doi.org/10.70749/ijbr.v3i6.2043Keywords:
Diabetic Retinopathy, Macular Edema, Sodium-glucose Transporter 2 Inhibitors.Abstract
Objectives: To determine the role of SGLT2 Inhibitors in diabetic retinopathy by comparing the incidence and severity of retinopathy in patients using SGLT2 inhibitors with those using other antidiabetic therapies. Study design: Case-control study. Place and duration of study: This study was conducted at the department of Medicine, PAF Hospital, Islamabad from Apr 2024-March 2025. Methods: A total of 300 type 2 diabetic patients using SGLT2 inhibitors (Dapagliflozin, Empagliflozin) for at least 3 consecutive years with HbA1c ≤7.5% were included as the study group. Another 300 patients on non-SGLT2 antidiabetic regimens, matched for treatment duration and glycemic control, were included as the control group. Primary objective was set as the incidence and severity of diabetic retinopathy. These primary outcomes were compared between the two groups to find the role of SGLT2 Inhibitors in diabetic retinopathy. Results: The mean age in this study was 53.76 ± 8.82 years (ranged from 34 to 70 years). Comparison of the incidence and severity showed a significantly lower incidence of diabetic retinopathy (˂0.01), non-proliferative retinopathy (p=0.02) and proliferative retinopathy (p=0.04) in the study group compared to the control group. However, difference was non-significant for the presence of advanced retinopathy or macular abnormalities (p=0.78). Conclusion: SGLT2 inhibitors demonstrated substantial preventive benefits in reducing the incidence and progression of diabetic retinopathy compared to other antidiabetic therapies, particularly for non-proliferative and proliferative retinopathy stages.
Downloads
References
1. Kropp, M., Golubnitschaja, O., Mazurakova, A., Koklesova, L., Sargheini, N., Vo, T. K., De Clerck, E., Polivka, J., Potuznik, P., Polivka, J., Stetkarova, I., Kubatka, P., & Thumann, G. (2023). Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications—risks and mitigation. EPMA Journal, 14(1), 21-42.
https://doi.org/10.1007/s13167-023-00314-8
2. Shukla, Unnati V., and Koushik Tripathy. “Diabetic Retinopathy.” PubMed, StatPearls Publishing, 2023,
www.ncbi.nlm.nih.gov/books/NBK560805/
3. Chen, Y., Radke, N. V., Amarasekera, S., Park, D. H., Chen, N., Chhablani, J., Wang, N., Wu, W., Ng, D. S., Bhende, P., Varma, S., Leung, E., Zhang, X., Li, F., Zhang, S., Fang, D., Liang, J., Zhang, Z., Liu, H., … Lam, D. S. (2025). Updates on medical and surgical managements of diabetic retinopathy and maculopathy. Asia-Pacific Journal of Ophthalmology, 14(2), 100180.
https://doi.org/10.1016/j.apjo.2025.100180
4. Haydinger, C. D., Oliver, G. F., Ashander, L. M., & Smith, J. R. (2023). Oxidative stress and its regulation in diabetic retinopathy. Antioxidants, 12(8), 1649.
https://doi.org/10.3390/antiox12081649
5. Padda, Inderbir S., et al. “Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors.” PubMed, StatPearls Publishing, 2023,
www.ncbi.nlm.nih.gov/books/NBK576405/
6. Sarzani, R., Giulietti, F., Di Pentima, C., & Spannella, F. (2020). Sodium-glucose Co-transporter-2 inhibitors: Peculiar “hybrid” diuretics that protect from target organ damage and cardiovascular events. Nutrition, Metabolism and Cardiovascular Diseases, 30(10), 1622-1632.
https://doi.org/10.1016/j.numecd.2020.05.030
7. McGuire, D. K., Shih, W. J., Cosentino, F., Charbonnel, B., Cherney, D. Z., Dagogo-Jack, S., Pratley, R., Greenberg, M., Wang, S., Huyck, S., Gantz, I., Terra, S. G., Masiukiewicz, U., & Cannon, C. P. (2021). Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes. JAMA Cardiology, 6(2), 148.
https://doi.org/10.1001/jamacardio.2020.4511
8. Wołos-Kłosowicz, K., Matuszewski, W., Rutkowska, J., Krankowska, K., & Bandurska-Stankiewicz, E. (2022). Will GLP-1 analogues and SGLT-2 inhibitors become new game changers for diabetic retinopathy? Journal of Clinical Medicine, 11(20), 6183.
https://doi.org/10.3390/jcm11206183
9. El Mouhayyar, C., Riachy, R., Khalil, A. B., Eid, A., & Azar, S. (2020). SGLT2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors in diabetes and Microvascular complications: A review. International Journal of Endocrinology, 2020, 1-11.
https://doi.org/10.1155/2020/1762164
10. Bonora, B. M., Avogaro, A., & Fadini, G. P. (2020). Extraglycemic effects of SGLT2 inhibitors: A review of the Evidence. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 161-174.
https://doi.org/10.2147/dmso.s233538
11. Yen, F., Wei, J. C., Yu, T., Hung, Y., Hsu, C., & Hwu, C. (2023). Sodium-glucose Cotransporter 2 inhibitors and risk of retinopathy in patients with type 2 diabetes. JAMA Network Open, 6(12), e2348431.
https://doi.org/10.1001/jamanetworkopen.2023.48431
12. Herat, L. Y., Matthews, J. R., Ong, W. E., Rakoczy, E. P., Schlaich, M. P., & Matthews, V. B. (2022). Determining the role of SGLT2 inhibition with Dapagliflozin in the development of diabetic retinopathy. Frontiers in Bioscience-Landmark, 27(12).
https://doi.org/10.31083/j.fbl2712321
13. Matthews, J., Herat, L., Rooney, J., Rakoczy, E., Schlaich, M., & Matthews, V. B. (2022). Determining the role of SGLT2 inhibition with Empagliflozin in the development of diabetic retinopathy. Bioscience Reports, 42(3).
https://doi.org/10.1042/bsr20212209
14. Sha, W., Wen, S., Chen, L., Xu, B., Lei, T., & Zhou, L. (2020). The Role of SGLT2 Inhibitor on the Treatment of Diabetic Retinopathy. Journal of Diabetes Research, 2020, 1–6.
https://doi.org/10.1155/2020/8867875
15. Mieno, H., Yoneda, K., Yamazaki, M., Sakai, R., Sotozono, C., & Fukui, M. (2018). The efficacy of sodium-glucose Cotransporter 2 (SGLT2) inhibitors for the treatment of chronic diabetic macular oedema in vitrectomised eyes: A retrospective study. BMJ Open Ophthalmology, 3(1), e000130.
https://doi.org/10.1136/bmjophth-2017-000130
16. Sabaner, M., Duman, R., Dogan, M., Akdogan, M., Vurmaz, A., Bozkurt, E., & Beysel, S. (2021). Do SGLT2 inhibitors prevent preclinical diabetic retinopathy? A prospective pilot optical coherence tomography angiography study. Journal Français d'Ophtalmologie, 44(8), 1159-1167.
https://doi.org/10.1016/j.jfo.2021.01.005
17. Lin, T.-Y., Kang, E. Y.-C., Shao, S.-C., Lai, E. C.-C., Garg, S. J., Chen, K.-J., Kang, J.-H., Wu, W.-C., Lai, C.-C., & Hwang, Y.-S. (2023). Risk of Diabetic Retinopathy between Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists. Diabetes & Metabolism Journal, 47(3), 394–404.
https://doi.org/10.4093/dmj.2022.0221
18. Lahoti, S., Nashawi, M., Sheikh, O., Massop, D., Mir, M., & Chilton, R. (2020). Sodium-glucose Co-transporter 2 inhibitors and diabetic retinopathy: Insights into preservation of sight and looking beyond. Cardiovascular Endocrinology & Metabolism, 10(1), 3-13.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research

This work is licensed under a Creative Commons Attribution 4.0 International License.