Association between Glucagon-like Peptide-1 Receptor Agonists and the Risk of Glaucoma in Individuals with Type 2 Diabetes

Purpose To examine the association between Glucagon-like Peptide-1 Receptor Agonists (GLP-1RA) use and the development of glaucoma in individuals with type 2 diabetes. Design Nationwide, nested case-control study. Participants From a nationwide cohort of 264708 individuals, we identified 1,737 incident glaucoma cases and matched them to 8685 glaucoma-free controls, all aged above 21 years old and treated with metformin and a second-line antihyperglycemic drug formulation, with no history of glaucoma, eye trauma or eye surgery. Methods Cases were incidence density matched to five controls by birth year, sex, and date of second-line treatment initiation. Main Outcome Measures Conditional logistic regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for glaucoma, defined by first-time diagnosis, first-time use of glaucoma-specific medication, or first-time glaucoma-specific surgical intervention. Results Compared with the reference group, who received treatments other than GLP-1RA, individuals who were exposed to GLP-1RA treatment exhibited a lower risk of incident glaucoma (HR: 0.81, CI: 0.70 - 0.94, p = 0.006). Prolonged treatment extending beyond three years lowered the risk even further (HR: 0.71, CI: 0.55 - 0.91, p = 0.007). Treatment with GLP-1RA for 0 - 1 years (HR: 0.89, CI: 0.70 - 1.14, p = 0.35) and 1 - 3 years (HR: 0.85, CI: 0.67 - 1.06, p = 0.15) were not significant. Conclusions GLP-1RA exposure was associated with a lower risk of developing glaucoma compared to receiving other second-line antihyperglycemic medication.