My view has been for the physician to start the best treatment to address the cardiovascular and systemic complications of diabetes whether Semaglutide or Mounjaro or Hybrid closed loop and we will manage the eye complications. A few points for your consideration.
- GLP-1 agonists and Tirzepatide may increase the risk of diabetic retinopathy worsening. This happens in the first few weeks to months of treatment.
- Semaglutide was associated with an increased risk of diabetic retinopathy in the Sustain 6 trial. This risk is higher in people with retinopathy. The risk relates to the rapid drop in HbA1C, similar to previous studies such as DCCT and UKPDS. However the primary endpoint in Sustain 6 was cardiovascular risks. FOCUS is an eye related study. The primary outcome in FOCUS is diabetic retinopathy worsening, secondary outcome is anti VEGF injections and vitrectomy. The results are due in Feb 2027.
- Patients should keep their screening appointment.
- They should chase up their diabetic eye clinic if their appointment is overdue.