Photo Credit: TefiM

The following is a summary of “Comparative Effects of Glucagon-like Peptide 1 Receptor Agonists and Metformin on Glaucoma Risk in Patients with Type 2 Diabetes,” published in the March 2025 issue of Ophthalmology by Muayad et al. 

Researchers conducted a retrospective study to compare the effects of glucagon-like peptide 1(GLP-1) receptor agonists and metformin on the risk of primary open-angle glaucoma (POAG), ocular hypertension, and the need for first-line glaucoma treatments in individuals with type 2 diabetes mellitus (T2DM).  

They analyzed electronic medical records from an international network covering May 2006 to 2024. Data from 120 healthcare organizations across 17 countries were used to assess individuals with T2DM treated with GLP1 receptor agonists or metformin. Outcomes were evaluated at 1, 2, and 3 years. Propensity score matching (PSM) balanced covariates, including demographics, comorbidities, and medication use and the risk ratios (RRs) with 95% CIs were estimated.  

The results showed that after PSM, both groups had 61,998 individuals at the 1-year follow-up, 27,414 at 2 years, and 14,100 at 3 years. Those receiving GLP-1 receptor agonists had a lower risk of developing POAG compared to metformin users at 1 year (RR, 0.59; 95% CI, 0.39–0.88), 2 years (RR, 0.50; 95% CI, 0.32–0.78), and 3 years (RR, 0.59; 95% CI, 0.37–0.94). Similar reductions were observed for ocular hypertension at 1 year (RR, 0.44; 95% CI, 0.31–0.62), 2 years (RR, 0.43; 95% CI, 0.30–0.62), and 3 years (RR, 0.51; 95% CI, 0.34–0.75). The need for first-line glaucoma treatment was also lower in the GLP-1 receptor agonist group at 1 year (RR, 0.63; 95% CI, 0.53–0.74), 2 years (RR, 0.71; 95% CI, 0.59–0.85), and 3 years (RR, 0.75; 95% CI, 0.62–0.91).  

Investigators concluded that GLP-1 receptor agonists, compared to metformin, significantly reduced the occurrence of POAG, ocular hypertension, and the requirement for initial glaucoma therapies in patients with T2DM, suggesting potential ocular advantages. 

Source: aaojournal.org/article/S0161-6420(24)00515-3/abstract