A recent study in Diabetologia revealed that tirzepatide is associated with higher incidence of proliferative diabetic retinopathy (PDR), especially in individuals with mild or moderate-to-severe non-proliferative diabetic retinopathy (NPDR) with or without maculopathy.
Many studies revealed that treatment with glucagon-like peptide-1 receptor agonists, including subcutaneous semaglutide, can cause Early worsening of diabetic retinopathy (EWDR).  However, whether EWDR occurs with tirzepatide (a glucagon-like peptide 1/gastric inhibitory polypeptide receptor agonist) has yet to be explored.
Researchers conducted a retrospective cohort study using real-world data. 3435 individuals exposed to tirzepatide (≥180 days of treatment) were matched 1:1 with 3434 individuals not exposed to tirzepatide for type 2 diabetes, based on sex, diabetes duration, retinopathy status, number of retinal screening episodes, HbA1c, and use of glucose-lowering medications. The researchers used the conditional logistic regression to evaluate the development and progression of new-onset diabetic retinopathy.
A mean HbA1c of 56.1 ± 15.8 mmol/mol was seen in individuals who were included in the study. In individuals exposed (n = 33)  and unexposed (n = 17) to tirzepatide and , new-onset proliferative diabetic retinopathy (PDR) (grade R3M0, R3M1) occurred in 1.1% and 0.5%, respectively. Tirzepatide was significantly associated with new-onset PDR after adjustment for established risk factors. However, a reduced odds of new onset of retinopathy in individuals without diabetic retinopathy (R0M0) at initiation was seen with tirzepatide in multivariate analysis. The study reported no association of mild non-proliferative diabetic retinopathy (NPDR, grade R1M0 or R1M1) with retinopathy progression with tirzepatide.