Risk of Developing Diabetic Retinopathy and Diabetic Macular Edema in Patients With Insulin Therapy Vs Newer Oral Hypoglycemic Agents (SGLT2i and GLP-1)
Author(s)
Aditi Paul, MBA1, Vikash Kumar Verma, MBA, PharmD1, Ina Kukreja, MBA, PT1, Anuj Gupta, M.SC2, Satish Kumar, MBA1, ritika pandey, MS2, Riddhi Markan, MSc2, Rahul Goyal, BS Tech3, Abhinav Nayyar, MBBS, MBA1, Abhimanyu Roy, MBA1, Arunima Sachdev, MA Economics4, Louis Brooks Jr, MA5, Marissa Seligman, BS Pharma4.
1OPTUM, GURGAON, India, 2OPTUM, NOIDA, India, 3OPTUM, Phoenix, AZ, USA, 4OPTUM, Boston, MA, USA, 5OPTUM, Bloomsbury, NJ, USA.
1OPTUM, GURGAON, India, 2OPTUM, NOIDA, India, 3OPTUM, Phoenix, AZ, USA, 4OPTUM, Boston, MA, USA, 5OPTUM, Bloomsbury, NJ, USA.
Presentation Documents
OBJECTIVES: Newer oral hypoglycemic agents are said to provide additional protection against retinopathy and macular edema other than diabetic control. Objective is to explore the impact of newer oral agents in preventing retinopathy & macular edema in patients with type 2 diabetes
METHODS: Optum® de-identified Market Clarity Dataset, which links medical, and pharmacy claims with EHR data was used to identify patients with type 2 diabetes from Jan 2016 to Dec 2020. Two intervention cohorts (patients on either SGLT2i or GLP1 with insulin) and one control cohort (patients only on Insulin) were identified from the pharmacy claims. Propensity score (1:1) was used to match patient cohorts based on age, gender, region, race/ethnicity, insurance type and baseline comorbidities. The analysis included patients who had both medical and pharmacy coverage and maintained continuous eligibility throughout the study and follow-up period. Patients were followed up for 3 years for occurrence of retinopathy and macular edema. The two intervention cohorts were compared against the control cohort and KM survival analysis was performed and hazard ratio was reported for each cohort.
RESULTS: Of 11,484 diabetic patients, the average age was 67.0 (12.5) years, 5,531 (48.1%) were female and 8,547 (74.4%) were Whites. 6,442 (56.0%) patients were found on only insulin therapy whereas 2,684 (23.3%) patients were on SLGT2i+Insulin and 2,358 (20.5%) patients were on GLP1+insulin therapy. 8,388 (73.0%) patients reported either retinopathy or macular edema in the follow up period. KM survival analysis showed lower risk of retinopathy and macular edema for patients with SGLT2i+insuline intervention cohort compared to the control group (HR:0.865, CI 95% 0.71-0.97, p<0.001) whereas higher risk was observed in GLP1+insulin cohort (HR: 1.21, CI 95% 1.18-1.25, p<0.05)
CONCLUSIONS: Use of SGLT2i with insulin was associated with better control of diabetic retinopathy compared to only insulin or GLP1.
METHODS: Optum® de-identified Market Clarity Dataset, which links medical, and pharmacy claims with EHR data was used to identify patients with type 2 diabetes from Jan 2016 to Dec 2020. Two intervention cohorts (patients on either SGLT2i or GLP1 with insulin) and one control cohort (patients only on Insulin) were identified from the pharmacy claims. Propensity score (1:1) was used to match patient cohorts based on age, gender, region, race/ethnicity, insurance type and baseline comorbidities. The analysis included patients who had both medical and pharmacy coverage and maintained continuous eligibility throughout the study and follow-up period. Patients were followed up for 3 years for occurrence of retinopathy and macular edema. The two intervention cohorts were compared against the control cohort and KM survival analysis was performed and hazard ratio was reported for each cohort.
RESULTS: Of 11,484 diabetic patients, the average age was 67.0 (12.5) years, 5,531 (48.1%) were female and 8,547 (74.4%) were Whites. 6,442 (56.0%) patients were found on only insulin therapy whereas 2,684 (23.3%) patients were on SLGT2i+Insulin and 2,358 (20.5%) patients were on GLP1+insulin therapy. 8,388 (73.0%) patients reported either retinopathy or macular edema in the follow up period. KM survival analysis showed lower risk of retinopathy and macular edema for patients with SGLT2i+insuline intervention cohort compared to the control group (HR:0.865, CI 95% 0.71-0.97, p<0.001) whereas higher risk was observed in GLP1+insulin cohort (HR: 1.21, CI 95% 1.18-1.25, p<0.05)
CONCLUSIONS: Use of SGLT2i with insulin was associated with better control of diabetic retinopathy compared to only insulin or GLP1.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO123
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Sensory System Disorders (Ear, Eye, Dental, Skin)