There has been an increase in the range of non-insulin anti-hyperglycaemic agents used to treat type 2 diabetes. With the globally rising rates of type 2 diabetes and complications such as diabetic retinopathy, it is important for ophthalmologists to be aware of these new agents and their impacts on diabetic retinopathy and diabetic macular oedema. We conducted a review of the literature to determine if there were any beneficial or harmful effects of the currently used anti-hyperglycaemic agents on diabetic retinopathy or diabetic macular oedema. Our review of the current literature found that apart from thiazolidinediones, anti-hyperglycaemic agents have been reported to have beneficial or neutral effects on diabetic eye complications. Thiazolidinediones (pioglitazone is the only one currently available) have been linked to incident or worsening diabetic macular oedema, although the rate is believed to be low. Glucagon-like peptide 1 (GLP1) agonists (incretins) in general are beneficial except semaglutide which is associated with increased rates of diabetic retinopathy complications. These results have implications for selection of anti-hyperglycaemic agents for patients with diabetic retinopathy or macular oedema. Further studies need to be conducted to identify if reported beneficial effects are independent of the impact of glycaemic control. Early worsening of retinopathy with tight glycaemic control should also be noted in interpretation of future studies.
目前用于治疗2型糖尿病的非胰岛素降糖药物的种类不断在增加。2型糖尿病与其并发症如糖尿病视网膜病 (DR) 的患病率在全球范围内升高, 因此眼科医生们知道这些新药物以及它们对DR和糖尿病性黄斑水肿 (DME) 发生与发展的影响十分重要。我们对现有降糖药物对于DR或DME的文献进行了分析与回顾。对现有的文献回顾发现, 除了噻唑烷二酮类, 其他降糖类药物对糖尿病眼部并发症的影响有益或中立。噻唑烷二酮类药物 (目前仅售吡格列酮) 与糖尿病性黄斑水肿的发生与恶化有关, 但发生率低。胰高血糖素样肽1 (GLP1) 激动剂 (肠促胰岛素类药物) 通常是有益的, 但是索马鲁肽与DR发生率的增加有关。这些结果提示对于并发DR与DME如何选择降糖药物。今后需要研究对DR及DME治疗有益的降糖药物的作用是否与血糖控制相关。血糖在严格控制达标下, 早期视网膜病变恶化也应成为今后的研究方向。