제2형 당뇨병 환자에서 메트포르민 병용 시 DPP-4 억제제 복용에 따른 당뇨망막병증 발생 위험

Risk of Diabetic Retinopathy associated with Dipeptidyl Peptidase-4 Inhibitor as an Add-on Therapy to Metformin in Type 2 Diabetes Mellitus

This study examined whether using dipeptidyl-peptidase-4 inhibitors (DPP4i) increases(or lowers) the risk of diabetic retinopathy compared to sulfonylurea (SU) or thiazolidinedione (TZD) as an add-on therapy to metformin (Met) in patients with type 2 diabetes (T2D). A nationwide, population-based cohort study was conducted using the Korea national health insurance claims database from 2011 through 2015. From the cohort, 146,137 adults with T2D were identified as having been treated with oral glucose-lowering agents (DPP-4i, SU, TZD) in addition to Met therapy between 2012 and 2014. Cox regression analysis was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for diabetic retinopathy. Total 16,517 cases of diabetic retinopathy occurred; 9,721 in DPP-4i+Met group, 659 in TZD+Met group and 6,137 in SU+Met group. The crude incidence rate was 54.8 cases per 1,000 person-years in DPP-4i+Met group compared with 47.1 in SU+Met group. Compared to SU as an add-on therapy to Met, DPP-4i significantly reduced the risk of diabetic retinopathy: the adjusted HRs was 0.87 (95% CI, 0.84-0.90). People with diabetes are at high risk of developing diabetic retinopathy. Since diabetic retinopathy is a serious complication that affects vision, managing diabetic retinopathy can improve the quality of life for diabetes patients. Our study showed that DPP-4i did not increase the risk of diabetic retinopathy compared to SU when used as a combination therapy with Met.