SAT-589 - Diabetic Retinopathy Outcomes in Patients with Type 1 Diabetes Taking GLP-1 Receptor Agonists

Introduction:
The impact of glucagon-like peptide-1 receptor agonists (GLP-1RA) on the progression of retinopathy in patients with diabetes remains unclear, particularly among those with type 1 diabetes (T1D) who are at heightened risk for sight-threatening diabetic retinopathy. As the off-label use of GLP-1RAs has become more prevalent in the T1D population, it is important to evaluate how these medications may influence the risk of developing retinopathy. This study aims to examine the potential relationship between GLP-1RA use and retinopathy outcomes in individuals with T1D.

Methods:
We conducted a retrospective cohort analysis using the Atropos Health Apollo electronic health record dataset, which encompasses over 140 million patients treated in community hospitals and academic medical centers across the U.S. between 1/1/2015 to 10/3/2025. Using ICD9/10 codes, RxNorm codes, and LOINC codes, we built a cohort of known T1D patients on insulin with obesity and no history of diabetic retinopathy. Participants were stratified into those initiated on GLP-1RA and those who were not, within the first 6 months after an index body mass index (BMI) measurement, applying high-dimensional propensity score matching (hdPS) to account for baseline differences.

Results:
After hdPS matching, baseline characteristics were similar between the GLP-1RA (n=16922) and non-GLP-1RA groups (n=16922): mean [SD] age, 58.0 [14] vs 58.8 [16.7] years; female sex, 53.8% vs 53.9%; White ethnicity, 56.6% vs 56.6%; and comorbidity scores, 5.7 [3.4] vs 6 [3.8]. In the subset who had BMI and hemoglobin A1c (HbA1c) data, BMI was 36.1 [10.1] vs. 35.1 [8.1] kg/m² and HbA1c was 8.6% [2.2] vs 8.3% [2.2]. After 6 to 24 months, the GLP-1RA group had significantly lower odds of developing mild non-proliferative (OR [95% CI], 0.704 [0.565, 0.879], p=0.002) and proliferative retinopathy (OR 0.677 [0.506, 0.907], p=0.009). The odds ratios for moderate non-proliferative (OR 0.698 [0.474, 1.03], p=0.067) and severe non-proliferative retinopathy (OR 0.5 [0.25, 0.999], p=0.05) were not statistically significant.

Conclusions:
Our findings suggest that GLP-1RA use in T1D patients without existing diabetic retinopathy may have a neutral to potentially protective effect against retinopathy development, despite the overall high comorbidity burden in our study population. Further research is needed to clarify the risk profile in T1D patients who have pre-existing retinopathy.

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