Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injection

AIM: To investigate the effects of dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on diabetic macular edema (DME) and the need for intravitreal injections (IVT) in patients with type 2 diabetes. METHODS: Data were retrospectively collected from the m...

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Main Authors: Yoo-Ri Chung, Chungwoon Kim, Eunzee Lee, Kihwang Lee
Format: Article
Language:English
Published: Press of International Journal of Ophthalmology (IJO PRESS) 2025-07-01
Series:International Journal of Ophthalmology
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Online Access:http://ies.ijo.cn/en_publish/2025/7/20250716.pdf
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author Yoo-Ri Chung
Chungwoon Kim
Eunzee Lee
Kihwang Lee
author_facet Yoo-Ri Chung
Chungwoon Kim
Eunzee Lee
Kihwang Lee
author_sort Yoo-Ri Chung
collection DOAJ
description AIM: To investigate the effects of dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on diabetic macular edema (DME) and the need for intravitreal injections (IVT) in patients with type 2 diabetes. METHODS: Data were retrospectively collected from the medical records of patients with diabetic retinopathy (DR) taking either DPP4i or SGLT2i as secondary oral hypoglycemic agents in addition to metformin between January 2019 and July 2022. We compared the prevalence of DME and the need for IVT among patients treated with DPP4i or SGLT2i. Propensity score matching was performed using the following variables: age, duration of diabetes, blood glucose control (HbA1c) level, and severity of DR. RESULTS: A total of 268 patients with DR were included in this study. More DPP4i users needed IVT than SGLT2i users (35.3% vs 18.0%, P=0.011), while the prevalence of DME was not different. The use of SGLT2i was associated with a lower need for IVT than DPP4i [odds ratio (OR) 0.404, 95% confidence interval (CI) 0.198–0.823], and similar trends were observed after propensity score matching (OR 0.419, 95%CI 0.181–0.970). However, this tendency was not significant in multiple logistic regressions. For DME, the use of DPP4i was not a significant risk factor compared to SGLT2i. CONCLUSION: The use of SGLT2i may be associated with a lower need for IVT for overall DR complications, while other factors may contribute to this effect. The effect of SGLT2i on the prevention of DME is not evident.
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publisher Press of International Journal of Ophthalmology (IJO PRESS)
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spelling doaj-art-3e64ffad911047f9bb59ef07d0ccd8ed2025-08-20T02:09:24ZengPress of International Journal of Ophthalmology (IJO PRESS)International Journal of Ophthalmology2222-39592227-48982025-07-011871326133210.18240/ijo.2025.07.1620250716Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injectionYoo-Ri Chung0Chungwoon Kim1Eunzee Lee2Kihwang Lee3Yoo-Ri Chung. Department of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Republic of Korea. hyalith@ajou.ac.kr; Kihwang Lee. Department of Ophthalmology, Seoul National University Hospital, Seoul 03080, Republic of Korea. 66255@snuh.orgDepartment of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Republic of KoreaDepartment of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Republic of KoreaDepartment of Ophthalmology, Seoul National University Hospital, Seoul 03080, Republic of KoreaAIM: To investigate the effects of dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on diabetic macular edema (DME) and the need for intravitreal injections (IVT) in patients with type 2 diabetes. METHODS: Data were retrospectively collected from the medical records of patients with diabetic retinopathy (DR) taking either DPP4i or SGLT2i as secondary oral hypoglycemic agents in addition to metformin between January 2019 and July 2022. We compared the prevalence of DME and the need for IVT among patients treated with DPP4i or SGLT2i. Propensity score matching was performed using the following variables: age, duration of diabetes, blood glucose control (HbA1c) level, and severity of DR. RESULTS: A total of 268 patients with DR were included in this study. More DPP4i users needed IVT than SGLT2i users (35.3% vs 18.0%, P=0.011), while the prevalence of DME was not different. The use of SGLT2i was associated with a lower need for IVT than DPP4i [odds ratio (OR) 0.404, 95% confidence interval (CI) 0.198–0.823], and similar trends were observed after propensity score matching (OR 0.419, 95%CI 0.181–0.970). However, this tendency was not significant in multiple logistic regressions. For DME, the use of DPP4i was not a significant risk factor compared to SGLT2i. CONCLUSION: The use of SGLT2i may be associated with a lower need for IVT for overall DR complications, while other factors may contribute to this effect. The effect of SGLT2i on the prevention of DME is not evident.http://ies.ijo.cn/en_publish/2025/7/20250716.pdfdiabetic macular edemadiabetic retinopathydipeptidyl peptidase-4 inhibitorintravitreal injectionsodium-glucose cotransporter-2 inhibitor
spellingShingle Yoo-Ri Chung
Chungwoon Kim
Eunzee Lee
Kihwang Lee
Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injection
International Journal of Ophthalmology
diabetic macular edema
diabetic retinopathy
dipeptidyl peptidase-4 inhibitor
intravitreal injection
sodium-glucose cotransporter-2 inhibitor
title Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injection
title_full Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injection
title_fullStr Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injection
title_full_unstemmed Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injection
title_short Sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic macular edema and the need for intravitreal injection
title_sort sodium glucose cotransporter 2 inhibitors and dipeptidyl peptidase 4 inhibitors on diabetic macular edema and the need for intravitreal injection
topic diabetic macular edema
diabetic retinopathy
dipeptidyl peptidase-4 inhibitor
intravitreal injection
sodium-glucose cotransporter-2 inhibitor
url http://ies.ijo.cn/en_publish/2025/7/20250716.pdf
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