Key points What is the association between diabetes medications and the common eye diseases open-angle glaucoma (OAG), age-related macular degeneration (AMD), and cataracts in an ethnic European population? Findings In this cohort study of 11,260 participants, metformin treatment was associated with a lower risk of OAG, while other diabetes medications were associated with a lower risk of AMD. No association was found between diabetes medication and cataracts. Meaning The finding that diabetes medication was associated with a reduced risk of OAG and AMD requires clinical trials to confirm causality. |
Importance
Recent studies suggest that the diabetes drug metformin has a protective effect on open-angle glaucoma (OAG) and age-related macular degeneration (AMD). However, studies have not addressed the critical issue of confounding by indication and associations have not been evaluated in a large prospective cohort.
Aim
To determine the association between diabetes medication and the common eye diseases OAG, AMD, and cataracts and evaluate their cumulative lifetime risks in a large cohort study.
Design, environment and participants
This cohort study included participants from 3 independent cohorts of the prospective population-based Rotterdam Study between April 23, 1990 and June 25, 2014.
Participants were monitored for incident ocular diseases (OAG, AMD, cataracts) and had baseline serum glucose measurements. Data on diabetes medication use and eye examination data were collected.
Exhibitions
Type 2 diabetes (T2D) and diabetes medications derived from metformin, insulin, and sulfonylurea.
Main results and measures
Diagnosis and cumulative lifetime risk of OAG, AMD, and cataract.
Results
This study included 11,260 participants (mean [SD] age, 65.1 [9.8]; 6610 women [58.7%]). T2D was diagnosed in 2,406 participants (28.4%), OAG was diagnosed in 324 of 7,394 participants (4.4%), AMD was diagnosed in 1,935 of 10,993 participants (17.6%), and cataract was diagnosed in 4,203 of 11,260 participants (37.3%).
Untreated T2D was associated with an increased risk of OAG (odds ratio [OR], 1.50; 95% CI, 1.06-2.13; P = 0.02), AMD (OR, 1.35 ; 95% CI, 1.11-1.64; P = 0.00). 003) and cataract (OR, 1.63; 95% CI, 1.39-1.92; P < 0.001).
Metformin -treated T2D was associated with a lower risk of OAG (OR, 0.18; 95% CI, 0.08-0.41; P < .001).
Other diabetes medications (ie, insulin, sulfonylurea derivatives) were associated with a lower risk of AMD (pooled OR, 0.32; 95% CI, 0.18 to 0.55; P < 0.001).
The lifetime cumulative risk of OAG was lower for people taking metformin (1.5%; 95% CI, 0.01%-3.1%) than for people without T2D (7.2%; 95% CI, 0.01%-3.1%). 95%, 5.7%-8.7%); the lifetime risk of AMD was lower for people taking other diabetes medications (17.0%; 95% CI, 5.8%-26.8% vs. 33.1%; 95% CI , 30.6%-35.6%).
Conclusions and relevance
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