Sodium-glucose cotransporter-2 inhibitors and risk of diabetic retinopathy in type 2 diabetes: a network meta-analysis of randomised clinical trials
Abstract
Introduction: Sodium-glucose cotransporter‑2 (SGLT‑2) inhibitors are widely used in type 2 diabetes, but their effect on the incidence of diabetic retinopathy remains uncertain.
Aim: To update the evidence on the relationship between SGLT-2 inhibitors and diabetic retinopathy incidence using a Bayesian network meta‑analysis (NMA) of randomised controlled trials (RCTs).
Method: A systematic search on Embase, PubMed, Web of Science, and ClinicalTrials.gov to 25 August 2025 identified RCTs in adults with type 2 diabetes comparing an SGLT‑2 inhibitor with placebo or active comparators and reporting diabetic retinopathy outcomes. A random‑effects Bayesian NMA estimated odds ratios (ORs) with 95% credible intervals (CrI) with ranking based on the surface under the cumulative ranking curve (SUCRA). Evidence quality was assessed using the Cochrane Risk-of-Bias tool and Confidence in Network Meta-Analysis (CINeMA). Network meta-regression explored treatment‑by‑covariate interactions including baseline diabetic retinopathy risk. Model‑based NMA (MBNMAdose) evaluated dose-response patterns.
Results: Thirty RCTs (eight gliflozins; 70,310 participants across study arms) formed a star‑shaped network without head‑to‑head trials. CINeMA indicated low confidence for most comparisons, mainly due to imprecision, with some concerns about indirectness and generally no concerns regarding heterogeneity or incoherence. No SGLT‑2 inhibitor altered diabetic retinopathy risk versus placebo (all 95%…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 70,310 participants or records.
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