Early worsening of diabetic retinopathy in individuals with type 2 diabetes treated with tirzepatide: a real-world cohort study – Published online 10/07/2025

Adam J. Buckley, Garry D. Tan, Marta Gruszka‑Goh, Peter H. Scanlon, Imran Ansari, Sara G. I. Suliman

Early worsening of diabetic retinopathy (EWDR) has been reported with the glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide. Whether the novel GLP-1RA/gastric inhibitory peptide (GIP) co-agonist tirzepatide also increases the risk of EWDR is unknown. In this issue, Buckley et al (https://doi.org/10.1007/s00125-025-06466-8) compare retinal outcomes of over 3000 people initiating tirzepatide with a matched group of unexposed individuals. The authors report that outcomes vary according to baseline eye status: tirzepatide more than doubles the risk of developing new onset proliferative diabetic retinopathy, particularly in those who have moderate-to-severe non-proliferative retinopathy or those with maculopathy at baseline. In contrast, starting tirzepatide in people with only background or no retinopathy at baseline actually reduces the risk of progression of eye disease. The authors conclude that individuals starting on tirzepatide can be stratified based on their baseline eye disease status: those with moderate-to-severe non-proliferative retinopathy or maculopathy should have their eye disease closely monitored, whilst those with less severe retinopathy do not require any additional screening.

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