Paradigm Shift in Diabetes Treatment... Ocular Side Effect Controversy Requires "Cautious Interpretation"

"GLP-1 Class Therapies Show Signs of Increased Optic Neuropathy Risk, but Causality Unconfirmed"

"Worsening of Retinopathy Linked to Rapid Blood Sugar Improvement"

"Importance of Prescription and Monitoring Under Specialist Supervision"

With the inclusion of GLP-1 (glucagon-like peptide-1) receptor agonists, including Ozempic (active ingredient semaglutide), in the national health insurance reimbursement program, access to treatment for domestic type 2 diabetes patients is expected to expand. Regarding the recent concerns in the academic community about ocular adverse effects, experts emphasized that "no direct causal relationship has been confirmed, and cautious interpretation is necessary."

On the 14th, experts spoke at the media session titled "Changes in the Treatment Paradigm for Type 2 Diabetes and Its Application in Domestic Clinical Practice," held at the Courtyard Marriott Seoul Myeongdong in Jung-gu, Seoul. Novo Nordisk Korea

On April 14, during the media session titled "Paradigm Shift in Type 2 Diabetes Treatment and Its Application in Domestic Clinical Practice" held at Courtyard Marriott Seoul Myeongdong, Jung-gu, Seoul, domestic experts predicted that "as the treatment paradigm for type 2 diabetes shifts from a focus on blood sugar to a broader consideration including weight, cardiovascular, and kidney diseases, the use of GLP-1 receptor agonists will further increase."

They added that, regarding the recent controversy over ocular side effects, "While some statistical associations have been reported, we need to continue monitoring as a direct causal link with the medication has yet to be established."

Ischemic optic neuropathy has been identified as a major ocular adverse effect in type 2 diabetes patients. According to a study published last year in the international journal JAMA Ophthalmology, the risk of ischemic optic neuropathy was about four times higher among patients using semaglutide compared to the general type 2 diabetes population, and about seven times higher in those who were overweight or obese.

Ischemic optic neuropathy is a condition in which vision suddenly deteriorates due to reduced or blocked blood flow to the optic nerve. It occurs more frequently in patients with vascular conditions such as hypertension, diabetes, or hyperlipidemia. In severe cases, it can result in permanent vision loss.

Cho Yoonkyung, Professor of Endocrinology at Asan Medical Center, Seoul, explained the association between GLP-1 receptor agonists and this condition, saying, "Retrospective analyses have shown a somewhat higher risk of this disease among patients who use these drugs compared to those who do not, and some statistical significance has been observed." However, she also stated, "The mechanism by which the medication might cause this condition has not yet been identified, so the direct causality remains uncertain."

Regarding the worsening of diabetic retinopathy, another mentioned ocular adverse effect, Professor Cho noted that it is difficult to view this as a side effect limited to GLP-1 receptor agonists.

She said, "It has long been known that when patients with high blood sugar rapidly improve their levels using medications such as insulin, retinopathy can worsen. Since GLP-1 receptor agonists have the characteristic of rapidly improving blood sugar, this phenomenon can occur, but it is not a distinctive side effect of GLP-1 receptor agonists or Ozempic specifically."

The experts emphasized the importance of the prescription environment from the perspective of managing side effects. Park Cheolyeong, Professor of Endocrinology at Kangbuk Samsung Hospital, stated, "Treatment and monitoring should be carried out under the supervision of a physician with appropriate experience," adding, "If not, the ability to evaluate the effectiveness of the treatment and monitor for adverse effects will be compromised, significantly raising the risk for patients."

Ozempic was first introduced in Korea as a non-reimbursed medication in September last year and was included in the health insurance reimbursement program on February 1 of this year. The reimbursement criteria are limited to patients who, after taking metformin and a sulfonylurea or insulin for two to four months, still have an HbA1c level of 7% or higher. Some have argued that these criteria are excessively strict.

This content was produced with the assistance of AI translation services.