MON-632 - Impact of SGLT2 Inhibitors Versus GLP-1 Receptor Agonists on Diabetic Macular Edema: A Systematic Review and Meta-Analysis

Introduction
Diabetic macular edema (DME) is a leading cause of visual impairment among patients with diabetes mellitus and represents a major microvascular complication with significant impact on quality of life and health insurance costs. Novel treatments for diabetes control have changed the progression of the disease and decreased its complications; however, their comparative impact on retinal outcomes, particularly DME incidence and progression, remains uncertain. This study aimed to evaluate the effects of SGLT2 versus GLP-1 RAs inhibitors on macular edema-related outcomes in patients with diabetes.
Methods
PubMed, Embase, and Cochrane Central databases were systematically searched up to for observational studies comparing SGLT2 inhibitors with GLP-1 RAs in adult patients with type 2 diabetes and reporting outcomes related to diabetic macular edema. Primary outcomes included incidence or progression of DME assessed by optical coherence tomography (OCT) or fundoscopic evaluation, secondary outcome was the development of proliferative diabetic retinopathy. A systematic review and meta-analysis were conducted. Statistical analyses were performed using R software (version 4.3.2). Heterogeneity was assessed using the Cochran Q test and I² statistics.
Results
A total of X studies were included, comprising 713685 patients, of whom 351436 received SGLT2 inhibitors and 362249 received GLP-1 RAs. We pooled hazard ratios to preserve the time-to-event nature of the outcomes across studies. In the pooled random-effects analysis, SGLT2 inhibitors were associated with a significantly lower hazard compared with GLP-1 receptor agonists (HR 0.81, 95% CI 0.73–0.90; p = 0.0001), with moderate heterogeneity (I² = 47%). No statistical significant evidence was found for the difference between SGLT-2 inhibitors and GLP-1 receptor agonists on proliferative diabetic retinopathy incidence.
Conclusion
In patients with diabetes, SGLT2 inhibitors appear to confer a more favorable retinal profile compared to GLP-1 receptor agonists, with a reduced risk of diabetic macular edema progression.
Keywords
Diabetic Macular Edema; GLP-1 Receptor Agonists; SGLT2 Inhibitors; Diabetic Retinopathy; Systematic Review; Meta-Analysis.

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