Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysis
BackgroundDiabetic retinopathy (DR) is the most frequent complication of type 2 diabetes and remains the leading cause of preventable blindness. Current clinical decisions regarding the administration of antidiabetic drugs do not sufficiently incorporate the risk of DR due to the inconclusive eviden...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1303238/full |
| _version_ | 1827391973675237376 |
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| author | Luyuan Tan Zhaonan Wang Kelvin Okoth Konstantinos A. Toulis Alastair K. Denniston Alastair K. Denniston Baldev M. Singh Baldev M. Singh Francesca L. Crowe Christopher Sainsbury Jingya Wang Krishnarajah Nirantharakumar |
| author_facet | Luyuan Tan Zhaonan Wang Kelvin Okoth Konstantinos A. Toulis Alastair K. Denniston Alastair K. Denniston Baldev M. Singh Baldev M. Singh Francesca L. Crowe Christopher Sainsbury Jingya Wang Krishnarajah Nirantharakumar |
| author_sort | Luyuan Tan |
| collection | DOAJ |
| description | BackgroundDiabetic retinopathy (DR) is the most frequent complication of type 2 diabetes and remains the leading cause of preventable blindness. Current clinical decisions regarding the administration of antidiabetic drugs do not sufficiently incorporate the risk of DR due to the inconclusive evidence from preceding meta-analyses. This umbrella review aimed to systematically evaluate the effects of antidiabetic drugs on DR in people with type 2 diabetes.MethodsA systematic literature search was undertaken in Medline, Embase, and the Cochrane Library (from inception till 17th May 2022) without language restrictions to identify systematic reviews and meta-analyses of randomized controlled trials or longitudinal studies that examined the association between antidiabetic drugs and DR in people with type 2 diabetes. Two authors independently extracted data and assessed the quality of included studies using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) checklist, and evidence assessment was performed using the GRADE (Grading of recommendations, Assessment, Development and Evaluation). Random-effects models were applied to calculate relative risk (RR) or odds ratios (OR) with 95% confidence intervals (CI). This study was registered with PROSPERO (CRD42022332052).ResultsWith trial evidence from 11 systematic reviews and meta-analyses, we found that the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), or dipeptidyl peptidase-4 inhibitors (DPP-4i) was not statistically associated with the risk of DR, compared to either placebo (RR: GLP-1 RA, 0.98, 0.89-1.08; SGLT-2i, 1.00, 95% CI 0.79-1.27; DPP-4i, 1.17, 0.99-1.39) or other antidiabetic drugs. Compared to other antidiabetic drugs, meglitinides (0.34, 0.01-8.25), SGLT-2i (0.73, 0.10-5.16), thiazolidinediones (0.92, 0.67-1.26), metformin (1.15, 0.81-1.63), sulphonylureas (1.24, 0.93-1.65), and acarbose (4.21, 0.44-40.43) were not statistically associated with the risk of DR. With evidence from longitudinal studies only, insulin was found to have a higher risk of DR than other antidiabetic drugs (OR: 2.47, 95% CI: 2.04-2.99).ConclusionOur results indicate that antidiabetic drugs are generally safe to prescribe regarding the risk of DR among people with type 2 diabetes. Further robust and large-scale trials investigating the effects of insulin, meglitinides, and acarbose on DR are warranted.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=332052, identifier CRD42022332052. |
| first_indexed | 2024-03-08T17:22:12Z |
| format | Article |
| id | doaj.art-dbb2c7f85eba448e851cd4a2a3a5b112 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-08T17:22:12Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-dbb2c7f85eba448e851cd4a2a3a5b1122024-01-03T04:38:36ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922024-01-011410.3389/fendo.2023.13032381303238Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysisLuyuan Tan0Zhaonan Wang1Kelvin Okoth2Konstantinos A. Toulis3Alastair K. Denniston4Alastair K. Denniston5Baldev M. Singh6Baldev M. Singh7Francesca L. Crowe8Christopher Sainsbury9Jingya Wang10Krishnarajah Nirantharakumar11Institute of Applied Health Research, University of Birmingham, Birmingham, United KingdomInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomAcademic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United KingdomNational Institute for Health and Care Research Birmingham Biomedical Research Centre, Birmingham, United KingdomWolverhampton Diabetes Centre, New Cross Hospital, The Royal Wolverhampton National Health Service Trust, Wolverhampton, United KingdomResearch Institute in Healthcare Sciences, Faculty of Science & Engineering, University of Wolverhampton, Wolverhampton, United KingdomInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomBackgroundDiabetic retinopathy (DR) is the most frequent complication of type 2 diabetes and remains the leading cause of preventable blindness. Current clinical decisions regarding the administration of antidiabetic drugs do not sufficiently incorporate the risk of DR due to the inconclusive evidence from preceding meta-analyses. This umbrella review aimed to systematically evaluate the effects of antidiabetic drugs on DR in people with type 2 diabetes.MethodsA systematic literature search was undertaken in Medline, Embase, and the Cochrane Library (from inception till 17th May 2022) without language restrictions to identify systematic reviews and meta-analyses of randomized controlled trials or longitudinal studies that examined the association between antidiabetic drugs and DR in people with type 2 diabetes. Two authors independently extracted data and assessed the quality of included studies using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) checklist, and evidence assessment was performed using the GRADE (Grading of recommendations, Assessment, Development and Evaluation). Random-effects models were applied to calculate relative risk (RR) or odds ratios (OR) with 95% confidence intervals (CI). This study was registered with PROSPERO (CRD42022332052).ResultsWith trial evidence from 11 systematic reviews and meta-analyses, we found that the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), or dipeptidyl peptidase-4 inhibitors (DPP-4i) was not statistically associated with the risk of DR, compared to either placebo (RR: GLP-1 RA, 0.98, 0.89-1.08; SGLT-2i, 1.00, 95% CI 0.79-1.27; DPP-4i, 1.17, 0.99-1.39) or other antidiabetic drugs. Compared to other antidiabetic drugs, meglitinides (0.34, 0.01-8.25), SGLT-2i (0.73, 0.10-5.16), thiazolidinediones (0.92, 0.67-1.26), metformin (1.15, 0.81-1.63), sulphonylureas (1.24, 0.93-1.65), and acarbose (4.21, 0.44-40.43) were not statistically associated with the risk of DR. With evidence from longitudinal studies only, insulin was found to have a higher risk of DR than other antidiabetic drugs (OR: 2.47, 95% CI: 2.04-2.99).ConclusionOur results indicate that antidiabetic drugs are generally safe to prescribe regarding the risk of DR among people with type 2 diabetes. Further robust and large-scale trials investigating the effects of insulin, meglitinides, and acarbose on DR are warranted.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=332052, identifier CRD42022332052.https://www.frontiersin.org/articles/10.3389/fendo.2023.1303238/fulltype 2 diabetesantidiabetic medicationsdiabetic retinopathymeta-reviewdiabetic complication |
| spellingShingle | Luyuan Tan Zhaonan Wang Kelvin Okoth Konstantinos A. Toulis Alastair K. Denniston Alastair K. Denniston Baldev M. Singh Baldev M. Singh Francesca L. Crowe Christopher Sainsbury Jingya Wang Krishnarajah Nirantharakumar Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysis Frontiers in Endocrinology type 2 diabetes antidiabetic medications diabetic retinopathy meta-review diabetic complication |
| title | Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysis |
| title_full | Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysis |
| title_fullStr | Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysis |
| title_full_unstemmed | Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysis |
| title_short | Associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes: an umbrella review and meta-analysis |
| title_sort | associations of antidiabetic drugs with diabetic retinopathy in people with type 2 diabetes an umbrella review and meta analysis |
| topic | type 2 diabetes antidiabetic medications diabetic retinopathy meta-review diabetic complication |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1303238/full |
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