Comparative Risk of Glaucoma in Patients Using Sodium-glucose Cotransporter-2 Inhibitors and Metformin: A Multinational Cohort Study.

Abstract

OBJECTIVE To compare the impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors and metformin on the risk of glaucoma-related outcomes in patients with type 2 diabetes mellitus (T2DM). DESIGN Multinational, retrospective clinical cohort study using patient data from 160 healthcare organizations across 21 countries. SUBJECTS Adults with T2DM who initiated SGLT2 inhibitors or metformin during 2013-2023 were included. INTERVENTION Patients with T2DM prescribed SGLT2 inhibitors were compared to those prescribed metformin. We performed 1:1 propensity score matching to balance age, sex, race, glycated hemoglobin, body mass index, medications, and comorbidities between the SGLT2 inhibitor and metformin groups. MAIN OUTCOME MEASURE The occurrence of ocular hypertension, primary open-angle glaucoma (POAG), and the need for glaucoma medications. RESULTS Our final analysis included 32,634 patients prescribed SGLT2 inhibitors and 32,634 prescribed metformin. Compared to metformin, SGLT2 inhibitors are associated with significantly lower risks of ocular hypertension (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.60-0.89), POAG (HR, 0.64; 95% CI, 0.51-0.81), and the need for glaucoma medications (HR, 0.76; 95% CI, 0.69-0.84) in 5 years. These associations remain consistent in patients aged ≥60 years, females, males, Whites, and those prescribed empagliflozin. CONCLUSIONS Among patients with T2DM, treatment with SGLT2 inhibitors may be associated with lower risks of ocular hypertension, POAG, and the need for glaucoma medications compared to metformin.