From the Guidelines
The probability of Ozempic worsening diabetic retinopathy is relatively low, but it is a recognized risk, particularly in patients with pre-existing retinopathy and during the initial period of rapid blood sugar improvement, as noted in the most recent guidelines 1.
Key Considerations
- The risk of worsening diabetic retinopathy with Ozempic is higher in patients who already have diabetic retinopathy, those with poorly controlled diabetes (HbA1c >9%), and those who experience rapid improvement in blood glucose levels after starting the medication.
- A meta-analysis of data from cardiovascular outcomes studies showed no association between glucagon-like peptide 1 receptor agonist (GLP-1 RA) treatment, such as Ozempic, and retinopathy per se, except through the association between retinopathy and average A1C reduction at the 3-month and 1-year follow-up 1.
- Intensive diabetes management with the goal of achieving near-normoglycemia has been shown to prevent and/or delay the onset and progression of diabetic retinopathy, reduce the need for future ocular surgical procedures, and potentially improve self-reported visual function 1.
Recommendations for Clinical Practice
- Patients with diabetes who are prescribed Ozempic should have a comprehensive eye examination before starting treatment and regular follow-up eye exams, especially during the first year of treatment.
- If a patient has a history of diabetic retinopathy, their healthcare provider might consider a more gradual dose escalation of Ozempic to minimize the risk of worsening retinopathy.
- It is crucial to balance the benefits of improved glycemic control with the potential risks of worsening diabetic retinopathy, and healthcare providers should closely monitor patients with pre-existing retinopathy 1.
From the FDA Drug Label
In a 2-year trial involving patients with type 2 diabetes and high cardiovascular risk, more events of diabetic retinopathy complications occurred in patients treated with OZEMPIC (3.0%) compared to placebo (1.8%). The absolute risk increase for diabetic retinopathy complications was larger among patients with a history of diabetic retinopathy at baseline (OZEMPIC 8.2%, placebo 5.2%) than among patients without a known history of diabetic retinopathy (OZEMPIC 0.7%, placebo 0.4%). Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy.
The probability of Ozempic worsening diabetic retinopathy is increased, particularly in patients with a history of diabetic retinopathy at baseline, with an absolute risk increase of 2.8% (8.2% - 5.2%) in this population, and 0.3% (0.7% - 0.4%) in patients without a known history of diabetic retinopathy 2.
From the Research
Ozempic and Diabetic Retinopathy
- There is no direct evidence in the provided studies to suggest that Ozempic (semaglutide) worsens diabetic retinopathy.
- However, a study on semaglutide, a glucagon-like peptide-1 receptor agonist, similar to Ozempic, found that it was not associated with increased diabetic retinopathy risk compared to controls when all trials were combined 3.
- Subgroup analysis showed that semaglutide was associated with an increased risk of diabetic retinopathy compared to placebo, particularly in patients aged 60 years or older and those with a diabetes duration of 10 years or more 3.
- Other studies focused on the treatment of diabetic retinopathy using anti-vascular endothelial growth factor (VEGF) therapy, corticosteroids, and emerging therapies, but did not mention Ozempic specifically 4, 5, 6.
- A study on metformin and sulfonylureas found that long-term treatment with these medications was associated with a reduced risk of diabetic retinopathy in people with newly diagnosed diabetes 7.
Mechanisms of Diabetic Retinopathy
- Diabetic retinopathy is a major cause of visual loss worldwide, characterized by diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) 4.
- Vascular endothelial growth factor (VEGF) plays a pivotal role in the retinal microvascular complications of diabetes, including diabetic retinopathy 5, 6.
- Anti-VEGF agents have been shown to improve outcomes in patients with diabetic retinopathy, including reducing retinal hemorrhages and progression of nonproliferative diabetic retinopathy 5.