{"title":"使用钠-葡萄糖共转运蛋白-2抑制剂和二甲双胍患者青光眼的比较风险:一项多国队列研究。","authors":"Ssu-Yu Pan,Chien-Hsiang Weng,Shang-Feng Tsai,Yi-Jing Sheen,Jun-Fu Lin,Ching-Heng Lin,I-Jong Wang,Chien-Chih Chou","doi":"10.1016/j.ajo.2025.09.027","DOIUrl":null,"url":null,"abstract":"OBJECTIVE\r\nTo 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).\r\n\r\nDESIGN\r\nMultinational, retrospective clinical cohort study using patient data from 160 healthcare organizations across 21 countries.\r\n\r\nSUBJECTS\r\nAdults with T2DM who initiated SGLT2 inhibitors or metformin during 2013-2023 were included.\r\n\r\nINTERVENTION\r\nPatients 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.\r\n\r\nMAIN OUTCOME MEASURE\r\nThe occurrence of ocular hypertension, primary open-angle glaucoma (POAG), and the need for glaucoma medications.\r\n\r\nRESULTS\r\nOur 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.\r\n\r\nCONCLUSIONS\r\nAmong 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.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"235 1","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative Risk of Glaucoma in Patients Using Sodium-glucose Cotransporter-2 Inhibitors and Metformin: A Multinational Cohort Study.\",\"authors\":\"Ssu-Yu Pan,Chien-Hsiang Weng,Shang-Feng Tsai,Yi-Jing Sheen,Jun-Fu Lin,Ching-Heng Lin,I-Jong Wang,Chien-Chih Chou\",\"doi\":\"10.1016/j.ajo.2025.09.027\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVE\\r\\nTo 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).\\r\\n\\r\\nDESIGN\\r\\nMultinational, retrospective clinical cohort study using patient data from 160 healthcare organizations across 21 countries.\\r\\n\\r\\nSUBJECTS\\r\\nAdults with T2DM who initiated SGLT2 inhibitors or metformin during 2013-2023 were included.\\r\\n\\r\\nINTERVENTION\\r\\nPatients 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.\\r\\n\\r\\nMAIN OUTCOME MEASURE\\r\\nThe occurrence of ocular hypertension, primary open-angle glaucoma (POAG), and the need for glaucoma medications.\\r\\n\\r\\nRESULTS\\r\\nOur 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.\\r\\n\\r\\nCONCLUSIONS\\r\\nAmong 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.\",\"PeriodicalId\":7568,\"journal\":{\"name\":\"American Journal of Ophthalmology\",\"volume\":\"235 1\",\"pages\":\"\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2025-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Ophthalmology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ajo.2025.09.027\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajo.2025.09.027","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Comparative Risk of Glaucoma in Patients Using Sodium-glucose Cotransporter-2 Inhibitors and Metformin: A Multinational Cohort Study.
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.
期刊介绍:
The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect.
The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports.
Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.