目的:比较胰高血糖素样肽-1(GLP-1)受体激动剂和二甲双胍对原发性开角型青光眼(POAG)风险的影响。高眼压,以及2型糖尿病患者对一线青光眼治疗的需求。
方法:使用来自国际电子健康记录网络的电子病历(EMR)数据进行了一项回顾性队列研究,涵盖2006年5月至2024年5月。
方法:诊断为2型糖尿病(T2DM)的患者接受GLP-1受体激动剂或二甲双胍治疗。
方法:分析了来自17个国家120个医疗机构的数据。在1年、2年和3年评估患者结果。倾向得分匹配(PSM)用于平衡协变量,如人口统计,合并症,和药物使用。计算风险比(RR)和95%置信区间(CI)。
方法:POAG发生率,高眼压,需要一线治疗,包括β受体阻滞剂,前列腺素类似物,溴莫尼定,布林佐胺,多佐胺,netarsudil,和激光小梁成形术.
结果:PSM后,两组在1年随访时包括61,998名患者,在2年的随访中,27,414,和14,100在3年的随访。与服用二甲双胍的患者相比,服用GLP-1受体激动剂的患者发生POAG的风险显著降低(RR0.59,95%CI0.39-0.88)。2年(RR0.50,95%CI0.32-0.78),和3年(RR0.59,95%CI0.37-0.94)。对高眼压有类似的保护作用,1年时风险降低56%(RR0.44,95%CI0.31-0.62),2年时57%(RR0.43,95%CI0.30-0.62),3年为49%(RR0.51,95%CI0.34-0.75)。GLP-1受体激动剂组在1年开始一线治疗的风险也较低(RR0.63,95%CI0.53-0.74),2年(RR0.71,95%CI0.59-0.85),和3年(RR0.75,95%CI0.62-0.91)。
结论:GLP-1受体激动剂与POAG的发病率显著降低有关,高眼压,与二甲双胍相比,2型糖尿病患者需要一线青光眼治疗。这些发现强调了GLP-1受体激动剂的潜在眼部益处及其在糖尿病患者临床管理中的扩展作用。
OBJECTIVE: To compare 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 patients with type 2 diabetes.
METHODS: A retrospective cohort study was conducted using electronic medical records (EMR) data from the from an international electronic health record network, covering a period from May 2006 to May 2024.
METHODS: Patients diagnosed with type 2 diabetes mellitus (T2DM) who were treated with either GLP-1 receptor agonists or metformin.
METHODS: Data from 120 healthcare organizations across 17 countries were analyzed. Patient outcomes were assessed at 1, 2, and 3 years. Propensity score matching (PSM) was used to balance covariates such as demographics, comorbidities, and medication usage. Risk ratios (RR) with 95% confidence intervals (CI) were calculated.
METHODS: Incidence of POAG, ocular hypertension, and the need for first-line treatments including beta-blockers, prostaglandin analogues, brimonidine, brinzolamide, dorzolamide, netarsudil, and laser trabeculoplasty.
RESULTS: After PSM, both groups included 61,998 patients at the 1-year follow-up, 27,414 at the 2-year follow-up, and 14,100 at the 3-year follow-up. Patients treated with GLP-1 receptor agonists had a significantly decreased risk of developing POAG compared to those on metformin 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 protective effects were observed for ocular hypertension with risk reductions of 56% at 1 year (RR 0.44, 95% CI 0.31-0.62), 57% at 2 years (RR 0.43, 95% CI 0.30-0.62), and 49% at 3 years (RR 0.51, 95% CI 0.34-0.75). The risk of first-line therapy initiation was also lower in the GLP-1 receptor agonists 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).
CONCLUSIONS: GLP-1 receptor agonists are associated with a significantly lower incidence of POAG, ocular hypertension, and the need for first-line glaucoma treatments compared to metformin in patients with type 2 diabetes. These findings highlight the potential ocular benefits of GLP-1 receptor agonists and their expanding role in the clinical management of diabetic patients.