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However, the SUSTAIN six trial evaluated semaglutide, a GLP-1 analog, in patients with type 2 diabetes and high cardiovascular risk and discovered that semaglutide was associated with a higher incidence of diabetic retinopathy complications compared to placebo, with a hazard ratio (HR) of 1.76, particularly in patients with pre-existing DR ( This seemingly controversial impact of GLP-1RAs on DR may be because most trials focused on microvascular and cardiovascular outcomes rather than DR

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Patients with diabetes who are initiating GLP-1 RAsespecially those with elevated baseline hemoglobin A1c or anticipated rapid reductionmay benefit from being monitored more closely than suggested by the American Academy of Ophthalmology preferred practice pattern, which is based on the current level of retinopathy

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