PMID- 37816862
OWN - NLM
STAT- MEDLINE
DCOM- 20231012
LR  - 20231123
IS  - 2045-2322 (Electronic)
IS  - 2045-2322 (Linking)
VI  - 13
IP  - 1
DP  - 2023 Oct 10
TI  - Sodium-glucose co-transporter 2 inhibitor add-on therapy for metformin delays 
      diabetic retinopathy progression in diabetes patients: a population-based cohort 
      study.
PG  - 17049
LID - 10.1038/s41598-023-43893-2 [doi]
LID - 17049
AB  - To investigate how sodium-glucose co-transporter 2 inhibitors (SGLT2is) add-on 
      therapy for metformin affects diabetic retinopathy (DR) progression in patients 
      with type 2 diabetes mellitus (T2DM). This nationwide population-based study 
      conducted from January 1, 2016, to December 31, 2018 involved 3,432,911 adults 
      with T2DM in Taiwan. To adjust for potential confounders, data on sex, age, 
      income, comorbidities, diabetes complication severity index score, staging of 
      kidney disease, anti-diabetic medications, and index year were included. The 
      outcome was DR progression, determined by procedure codes or the addition of 
      ICD-9-CM or ICD-10-CM codes to the medical records of the patients during the 
      study. Sensitivity analyses were performed to validate the findings. The adjusted 
      hazard ratio (aHR) of DR progression was 0.89 for the SGLT2is add-on group, 
      relative to the control group [95% confidence interval (CI) 0.81-0.99, 
      P = 0.026]. The Kaplan-Meier curve of the cumulative incidence rate showed that 
      the cumulative incidence of DR progression was considerably decreased in the 
      SGLT2is cohort (log-rank P = 0.0261). The use of SGLT2is for less than 1 year and 
      1-2 years were associated with a significant increase in the risk of DR 
      progression (aHR 1.56 and 1.88, respectively); however, the risk markedly reduced 
      if the SGLT2is regimen was used for more than 2 years (aHR 0.41, 95% Cl 
      0.35-0.48; P < 0.001). The serial sensitivity analysis showed consistent 
      findings. The aHR of DR progression was 0.82 for the SGLT2is cohort relative to 
      the non-SGLT2is cohort based on the fundoscopy or indirect ophthalmoscopy 
      findings within 1 year before the outcome date (95% Cl 0.71-0.95; P = 0.009). 
      Co-administration of metformin and SGLT2is may reduce the risk of DR progression. 
      Short-term use of SGLT2is may markedly increase the risk of DR, whereas prolonged 
      use SGLT2is may significantly decrease it.
CI  - (c) 2023. Springer Nature Limited.
FAU - Li, Jing-Xing
AU  - Li JX
AD  - Department of Internal Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.
AD  - School of Medicine, China Medical University, Taichung, Taiwan.
AD  - Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, 
      National Taiwan University, Taipei, Taiwan.
FAU - Hung, Yu-Tung
AU  - Hung YT
AD  - Institute of Public Health, China Medical University Hospital, Taichung, Taiwan.
FAU - Bair, Henry
AU  - Bair H
AD  - Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.
AD  - Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA.
FAU - Hsu, Shu-Bai
AU  - Hsu SB
AD  - Department of Nursing, China Medical University Hospital, Taichung, Taiwan.
AD  - School of Nursing, China Medical University, Taichung, Taiwan.
FAU - Hsu, Chung-Yi
AU  - Hsu CY
AD  - Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 
      Taiwan.
FAU - Lin, Chun-Ju
AU  - Lin CJ
AD  - School of Medicine, China Medical University, Taichung, Taiwan. 
      doctoraga@gmail.com.
AD  - Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan. 
      doctoraga@gmail.com.
AD  - Department of Optometry, Asia University, Taichung, Taiwan. doctoraga@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20231010
PL  - England
TA  - Sci Rep
JT  - Scientific reports
JID - 101563288
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Cohort Studies
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy/epidemiology
MH  - *Diabetic Retinopathy/complications
MH  - Hypoglycemic Agents/therapeutic use
MH  - *Metformin/therapeutic use
MH  - Retrospective Studies
MH  - *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
PMC - PMC10564914
COIS- The authors declare no competing interests.
EDAT- 2023/10/11 00:42
MHDA- 2023/10/12 06:43
PMCR- 2023/10/10
CRDT- 2023/10/10 23:33
PHST- 2023/02/01 00:00 [received]
PHST- 2023/09/29 00:00 [accepted]
PHST- 2023/10/12 06:43 [medline]
PHST- 2023/10/11 00:42 [pubmed]
PHST- 2023/10/10 23:33 [entrez]
PHST- 2023/10/10 00:00 [pmc-release]
AID - 10.1038/s41598-023-43893-2 [pii]
AID - 43893 [pii]
AID - 10.1038/s41598-023-43893-2 [doi]
PST - epublish
SO  - Sci Rep. 2023 Oct 10;13(1):17049. doi: 10.1038/s41598-023-43893-2.