GLP1-RA Use and Risk of Non-arteritic Anterior Ischemic Optic Neuropathy in Patients with Type 2 Diabetes
- Design
- Retrospective cohort · 19505 participants · Hard outcome
- Match to healthy normal-weight adults aged 55–75
- Different population[Auto] Participants had type 2 diabetes (age/BMI not reported in abstract).
- Could weight loss explain it?
- Unknown[Auto] Harm signal; weight-loss mediation not the relevant question, but consider whether harms relate to rapid weight loss or reduced intake.
- Study tier
- Study tier 3[Auto] Observational design; confounding by indication and healthy-user effects cannot be excluded (auto-provisional).
- Assessment
- Version 1 · automatic, not yet reviewed by a person · Sep 13, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
[Auto, unreviewed; quoted from abstract conclusions] Our findings indicate that GLP-1 RA use, particularly liraglutide, may be associated with an increased risk of NAION among patients with T2DM. Further research is warranted to confirm these findings and clarify the biological mechanisms linking GLP-1 RA use to NAION.
01Findings
What the study reported
- Drugs
- Liraglutide
- Comparator
- those initiating SGLT-2i or DPP-4i
- Primary outcome
- Not extracted
- Effect
- Not extracted
- 95% confidence interval
- Not extracted
- Follow-up
- 18 months of follow-up
- Adverse events
- Not extracted
- Limitations
- Auto-classified from abstract only; effect estimates, adverse events and limitations not extracted. Requires manual review.
Who was studied
- Diabetes status
- type 2 diabetes present (all or most)
- Sample size
- 19505
Study quality details
- Study design
- Retrospective cohort
- Sample size
- 19505
- Randomization
- no
- Blinding
- not stated
- Comparator
- not stated
- Follow up duration
- 18 months of follow-up
- Outcome type
- hard
- Replication
- not assessed (auto)
- Consistency with other evidence
- not assessed (auto)
- Population applicability
- INDIRECT
- Statistical precision
- not extracted
- Risk of bias
- not assessed (auto)
- Funding conflicts
- unclear
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- None identified
- Sponsor role
- not reported in abstract
- Author conflicts
- not available in metadata
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[IMPORTANCE] Concerns have been raised regarding the increased risk of non-arteritic ischemic optic neuropathy (NAION) associated with the use of glucagon-like peptide 1 receptor agonist (GLP-1 RA). However, findings remain inconsistent due to differences in indications for drug use, comparator groups, follow-up periods, and study populations. [OBJECTIVE] This study aims to examine the association between GLP-1 RA use and the risk of NAION among U.S. patients with type 2 diabetes mellitus (T2DM) enrolled in private health plans. [DESIGN, SETTING, AND PARTICIPANTS] This retrospective cohort study was conducted based on health administrative claims data from 2012 to 2024. Target trial emulation was applied, using a new user design and active comparators, to compare the risk of NAION between patients initiating GLP-1 RAs and those initiating sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or dipeptidyl peptidase-4 inhibitors (DPP-4i). Propensity score methods were utilized to balance baseline demographic and clinical characteristics between the comparison groups. Cox proportional hazard models were applied to estimate adjusted hazard ratios (HR) of NAION incidence associated with GLP-1 RAs, relative to SGLT-2i or DPP-4i. [EXPOSURES] Participants initiating GLP-1 RAs compared with those initiating SGLT-2i or DPP-4i for the treatment of T2DM. [MAIN OUTCOMES AND MEASURES] Incidence of NAION in the comparison groups and the adjusted hazard ratios between groups. [RESULTS] A total of 19,505 adult patients diagnosed with T2DM were included, with 9,213 (47.2%) using GLP-1 RAs, 10,292 (52.8%) exposed to SGLT-2i or DPP-4i, and 29 incidences of NAION. Compared with SGLT-2i or DPP-4i, overall GLP-1 RA use was not significantly associated with a higher risk of NAION (HR: 1.87; 95%CI: 0.85-4.12). However, risk of NAION among liraglutide users was higher than for SGLT-2i or DPP-4i users within 12 or 18 months of follow-up. Additionally, the elevated risk of NAION associated with GLP-1 RAs relative to SGLT-2i or DPP-4i was observed in males and older adults. [CONCLUSIONS AND RELEVANCE] Our findings indicate that GLP-1 RA use, particularly liraglutide, may be associated with an increased risk of NAION among patients with T2DM. Further research is warranted to confirm these findings and clarify the biological mechanisms linking GLP-1 RA use to NAION.