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In the post-hoc analysis of Sustain-6, semaglutide increased early worsening (EW) of diabetic retinopathy (DR) in patients recruited to the study. We report a case of type 2 diabetes complicated with EW of DR, treated with continuous short acting lixisenatide followed by exenatide twice a day. A 43-year-old man diagnosed as overt type 2 diabetes with 10.7% of HbA1c having two-year history with obesity was treated with lixisenatide and switched to exenatide. After strict control by GLP-1RA and metformin, OCT confirmed the development of macular edema. He was treated with Ranibizumab injection and remission of macular edema was recognized after 1 year under the continuous treatment with exenatide. This case supports the notion that EW can occur in both types of diabetes mellitus and be a phenomenon associated with the rapidity and magnitude of improvement in glycemic control by GLP-1RA regardless of the use of insulin. Our case also exhibited remission from EW under continuous strict control by short acting GLP-1RA and assured the effect of ranibizumab on macular edema observed in EW.

Intervention of Type 2 Diabetes With GLP-1RA Caused Early Worsening and Remission of Diabetic Retinopathy