Abstract: SA-PO0527
Comparative Effectiveness of GLP-1 Receptor Agonists, SGLT2 Inhibitors, and Insulin Glargine on Glycemic Control and Incident Retinopathy in a National Cohort of Veterans with Type 2 Diabetes (T2D) and CKD
Session Information
- CKD: Clinical - Therapies, CKM Health, Special Populations, and More
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Hamm, Kaila Madison, Cardiovascular, Renal and Metabolism Center, University of Utah, Salt Lake City, Utah, United States
- Throolin, Michael J., Cardiovascular, Renal and Metabolism Center, University of Utah, Salt Lake City, Utah, United States
- Wei, Guo, Cardiovascular, Renal and Metabolism Center, University of Utah, Salt Lake City, Utah, United States
- Melo, Isabelle, Cardiovascular, Renal and Metabolism Center, University of Utah, Salt Lake City, Utah, United States
- Nevers, Mckenna R., University of Utah Health, Salt Lake City, Utah, United States
- Curtis, Christa A., University of Utah Health, Salt Lake City, Utah, United States
- Hartsell, Sydney Elizabeth, Cardiovascular, Renal and Metabolism Center, University of Utah, Salt Lake City, Utah, United States
- Shen, Jincheng, Cardiovascular, Renal and Metabolism Center, University of Utah, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, Cardiovascular, Renal and Metabolism Center, University of Utah, Salt Lake City, Utah, United States
Background
There are concerns that GLP1-RA might increase the risk of incident diabetic retinopathy, particulary with rapid glycemic control. Hence, we examined the comparative effects of GLP-RA, SGLT2i and insulin glargine on the risk of incident diabetic retinopathy in veterans with CKD.
Methods
In an active-control, new-user design study of national VA data, there were 17,832 veterans who met the following criteria: T2D on metformin, CKD (eGFR < 60), without diabetic retinopathy at baseline and initiated on SGLT2i (n= 8777), GLP1-RA (n= 2564) or IG (n = 6481) for the first time between 01/01/2018 and 12/31/2021. Follow-up was until 12/31/2023. Inverse probability treatment weights (IPTW) were used to balance baseline variables. In IPTW mixed effect model, we related study drugs initiation to 6-month average of follow-up A1C values upto 24 months. We related study drugs initation with time to incident diabetic retinopathy or incident diabetic retinopathy/ death In separate IPTW Cox models.
Results
Mean age was 70.9 ± 8.4 yrs and mean eGFR was 50.6 ± 7.5. was The incidence of retinopathy in SGLT2i, GLP-1 RA and IG were 2093 events/ 19203 person-years, 771 events/ 6585 person-years and 2502 events/ 17047 person-years , respectively. IG achieved better glycemic conttol compared to SGLT2i or GLP-1 RA (Table). The risk of incident retinopathy was similar across the three drug classes but IG had higher risk of retinopathy/ death composite (Figure).
Conclusion
There was no evidence that GLP-1 RA increased the risk of incident diabetic retinopathy in T2D with CKD. While insulin glargine achieved better glycemic control, it had higher risk of retinopathy/ death composite.
Mean A1C and 95% CI from Baseline to 24 Months for IG, GLP-RA, and SGLT2i
| Time Since Baseline (Months) | Insulin Glargine Mean (95%CI) | GLP1-RA Mean (95%CI) | SGLT2i Mean (95%CI) |
| Baseline | 9.6 (9.58-9.69) | 8.7 (8.63-8.76) | 8.3 (8.25-8.31) |
| 6 | 8.1 (8.09-8.18) | 7.7 (7.61-7.72) | 7.8 (7.72-7.78) |
| 12 | 7.8 (7.79-7.88) | 7.5 (7.45-7.57) | 7.6 (7.58-7.63) |
| 18 | 7.8 (7.77-7.86) | 7.5 (7.43-7.55) | 7.6 (7.53-7.59) |
| 24 | 7.8 (7.75-7.84) | 7.5 (7.45-7.58) | 7.5 (7.49-7.55) |
Funding
- NIDDK Support