Diabetes Drug Class Linked to Vision Threat

New Research Flags Potential Risk of Optic Nerve Damage

Patients managing type 2 diabetes with certain widely used medications are being alerted to a potential sight-threatening side effect. A recent study has identified a link between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and nonarteritic anterior ischemic optic neuropathy (NAION), a condition that can cause significant nerve damage.

Study Uncovers Association with Common Diabetes Treatments

The research, published in JAMA Ophthalmology, investigated the connection between various GLP-1 RAs and NAION. Previous research had hinted at a possible link with semaglutide, but this study broadened the scope to encompass other medications within the GLP-1 RA class.

NAION is recognized as the primary cause of sudden optic nerve injury in individuals aged 50 and older. White individuals appear to be at a higher risk compared to other ethnic groups. The study’s findings indicate that patients prescribed GLP-1 RAs experienced a statistically higher incidence of NAION.

Methodology and Findings

Researchers analyzed data from over 3.8 million individuals aged 65 and older who were diagnosed with type 2 diabetes and enrolled in Medicare between 2007 and 2021. Diagnostic codes were utilized to identify cases of type 2 diabetes and NAION, with exclusions for conditions like optic neuritis and giant cell arteritis.

The study found that GLP-1 RAs were associated with an elevated risk of NAION, with a hazard ratio of 1.15. Medications like semaglutide and liraglutide specifically showed increased risks. Interestingly, insulin was also linked to a greater risk of NAION compared to metformin monotherapy.

Certain factors emerged as additional risk indicators for NAION, including male sex, White race, rural living, a history of diabetic retinopathy, and the use of amiodarone.

Limitations and Future Directions

The study authors acknowledged certain limitations, such as the potential for undercounting NAION cases due to reliance on diagnostic codes. Furthermore, the absence of specific onset dates for type 2 diabetes and the age restriction of participants to 65 and older mean that the findings may not be universally generalizable.

Despite these limitations, the authors concluded that their results corroborate previous findings. They emphasized the need for further investigation into this risk, citing the expanding use of GLP-1 RAs and the serious consequences of NAION.

The growing popularity of GLP-1 RAs for diabetes management, exemplified by the over 5 million prescriptions issued annually in the U.S. for semaglutide alone, underscores the importance of understanding these potential risks (GoodRx, 2024).

“The risk of NAION warrants further research given the increasing use of GLP-1 RAs and the seriousness of NAION.”

—Study Authors