Long-term use of semaglutide and risk of diabetic retinopathy progression

Concerns exist about semaglutide, potentially worsening sight-threatening diabetic retinopathy (DR) in individuals with diabetes. This study aimed to explore the association between semaglutide and the risk of DR progression over three years in patients with type 2 diabetes (T2D). It is hypothesized that any observed deterioration in DR among T2D patients following semaglutide use would be temporary and unrelated to long-term progression. Retrospective data analysis identified 4086 patients with T2D and DR by ICD-10 codes in a Retina only practice from January to June 2020. Use of semaglutide was found in 116 patients. Inclusion criteria included at least 1 year of semaglutide use and documentation of level of non-proliferative (NPDR) and proliferative (PDR) retinopathy, visual acuity (VA) and Central Subfield Thickness (CST). 87 patients meeting the eligibility criteria, ranging in age from 38 to 84 years (mean age of 62.4 years), and having an average duration of semaglutide usage of approximately 2.9 years. Gender distribution included 58.6 % male and 41.4 % female patients, with 83.9 % Caucasian, 11.5 % Black, and 10.3 % Hispanic backgrounds. The baseline HbA1c level averaged 7.6 %, ranging from 5.9 % to 10.9 %, with a standard deviation of 1.1. The last self-reported HbA1c level averaged 7.4 %, ranging from 5.2 % to 14 %, with a standard deviation of 1.5. Baseline DR severity correlated with progression risk: 2.7 % for DRSS level ≤ 43, 28 % for levels 47/53, and 45 % for baseline PDR. Patients required an average of 12.6 intravitreal injections. Visual acuity remained stable for 72.4 % of patients, with 16.1 % experiencing a loss and 11.5 % achieving improvement. Semaglutide use was not associated with increased risk of progression of DR, visual loss, or an increased number of intravitreal injections over a 3-year period of time. [Display omitted] •Of the 87 patients (174 eyes), 14.4 % had severe NPDR at the outset.•The progression rate to PDR for those with severe NPDR over a year historically is 50 %.•3-Year progression rate to PDR for those with severe NPDR on semaglutide was 28 %.•63.2 % of patients required intravitreal injections, averaging 6.1 injections per patient.•Visual acuity over 3 years: 72.4 % stable, 16.1 % loss, and 11.5 % gain