GLP-1 Receptor Agonists Modulate Retinal Microvascular Alterations in Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a leading cause of microvascular complications, including diabetic retinopathy, which significantly impacts vision. Current treatments primarily focus on glycemic control, yet microvascular damage often progresses due to underlying endothelial dysfunction, oxidative stress, and inflammation. GLP-1 receptor agonists (GLP-1RAs), while known for robust glycemic control and cardioprotection, also exhibit pleiotropic actions on endothelial function, oxidative stress, inflammation, and vascular remodeling. These pathways are central to the pathogenesis of diabetic microangiopathy, suggesting a broader role for GLP-1RAs in preserving retinal microvascular integrity beyond their glucose-lowering effects. The retinal microvasculature, a complex network of arterioles, capillaries, and venules, is critical for nutrient delivery to neural tissue, and its dysfunction, driven by hyperglycemia-induced NF-κB activation and reduced nitric oxide bioavailability, disrupts the inner blood-retinal barrier.