Five diabetic eye disease updates from ADA 2026

New data presented at ADA 2026 explored diabetic retinopathy risk, incretin therapy safety, AI-based screening, real-world DME outcomes and a potential new oral approach to retinal vascular disease.

With diabetic eye disease sitting at the intersection of endocrinology, primary care and ophthalmology, several abstracts at the American Diabetes Association (ADA) 2026 Scientific Sessions in New Orleans (June 5-8) may be of interest to ophthalmologists. Together, the data highlight a familiar but evolving story: earlier risk identification, better systemic–ophthalmic coordination and new approaches to preventing or treating retinal complications could all shape future care.

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1. CGM metrics may offer more insight than HbA1c for microvascular risk

A multicenter study from Saudi Arabia assessed whether continuous glucose monitoring (CGM)-derived metrics were associated with diabetic retinopathy (DR), albuminuria and a composite microvascular outcome in 370 people with type 1 diabetes.¹ Participants with time in range (TIR) >50% had lower rates of DR, albuminuria and composite microvascular complications than those with TIR ≤50%. Higher glycemia risk index categories were also associated with higher rates of albuminuria and composite complications.

After adjustment, diabetes duration of ≥10 years, TIR ≤60% and glycemia risk index >80 remained significant predictors of retinopathy, while HbA1c was not independently associated with microvascular outcomes. For ophthalmologists, these findings reinforce the potential value of looking beyond HbA1c when assessing retinal risk, particularly as CGM becomes more widely embedded in diabetes care.

2. Tirzepatide showed no meaningful worsening of retinopathy versus dulaglutide

Rapid improvement in glycemia can raise concerns about short-term worsening of DR. The SURPASS-CVOT retinopathy substudy compared retinal outcomes after tirzepatide or dulaglutide in 920 participants with type 2 diabetes, established cardiovascular disease and either existing DR or high risk for DR. Standardized fundus photographs were graded by blinded central readers using an ETDRS-based approach.²

Tirzepatide produced greater HbA1c reduction than dulaglutide at 6 months, but there were no meaningful mean changes in DR status at 12 months and no difference between treatment groups. In patients with baseline DR, small mean ETDRS score increases were seen in both arms, but the between-treatment difference was not significant. These data may be reassuring for clinicians managing patients with long-standing diabetes who are starting potent incretin-based therapy, although continued retinal monitoring remains important in high-risk individuals.

3. AI retinal screening may help connect primary care and ophthalmology

A Phase 1 implementation study at Emory Healthcare evaluated AEYE Health across primary care sites, with ophthalmology verification using ETDRS criteria.³ Between April and December 2025, there were 1,635 screening attempts and 771 screening encounters. The AI system identified 108 patients with more than mild DR, while 114 patients with negative results were also reviewed during part of the study period.

More than half of patients requiring referral had ophthalmology follow-up scheduled, although delays were commonly driven by patient-related factors. The study also highlighted practical limitations, including photography dependence, imaging staff learning curves, technical issues and glaucoma concerns in both positive and negative groups. For ophthalmology services, the message is pragmatic: AI screening may improve access and referral pathways, but it still needs careful workflow design, human oversight and a plan for incidental findings.

4. Baseline diabetes severity may influence outcomes in faricimab-treated DME

A linked analysis of administrative claims and American Academy of Ophthalmology IRIS Registry data examined clinical and economic outcomes in 902 patients, representing 1360 eyes, who initiated faricimab for diabetic macular edema (DME).⁴ Patients were stratified by baseline diabetes severity using the claims-based Diabetic Complication Severity Index.

Baseline visual acuity was similar across severity groups, but the lowest diabetes severity group had the highest proportion of eyes gaining ≥5 ETDRS letters, although this trend was not statistically significant. All-cause and diabetes-related healthcare costs increased with greater diabetes severity, while DME-related costs excluding anti-VEGF were similar across groups. The findings support a coordinated care message: ocular outcomes in DME do not sit in isolation from systemic disease burden, and optimizing diabetes management may matter alongside intravitreal therapy.

5. Oral NLRP3 inhibition preserved retinal vascular integrity in a preclinical DR model

A late-breaking preclinical study evaluated BGE-102, an oral brain-penetrant NLRP3 inhibitor, in a streptozotocin-induced mouse model of DR.⁵ The rationale was that hyperglycemia-driven NLRP3 inflammasome activation contributes to retinal vascular leakage, and that an oral anti-inflammatory approach could potentially address an unmet need beyond intravitreal therapy.

Despite persistent hyperglycemia, BGE-102 reduced retinal vascular permeability versus vehicle by 74% at 20 mg/kg and 98.7% at 50 mg/kg, with the higher dose restoring fluorescein angiography signal to healthy control levels. It also restored tight junction integrity, assessed by Claudin-5 immunohistochemistry, to 95% and 97% of healthy control levels at the two doses. Although early and preclinical, the findings point to a possible future direction for DR and DME: systemic oral therapies aimed at retinal vascular integrity, with a Phase 1b/2a DME trial planned.

Clinical takeaway

For ophthalmologists, these ADA 2026 abstracts underline how diabetic eye disease is increasingly being shaped by data and decisions made outside the retina clinic. CGM metrics may help refine risk prediction, incretin therapy safety data may inform monitoring conversations, AI screening could strengthen referral pathways, real-world DME outcomes continue to reflect systemic disease burden, and oral inflammatory pathway inhibition may offer a future route to earlier intervention.

References:

1. Al-Sofiani ME, et al. CGM-derived metrics outperform hemoglobin A1c in predicting microvascular complications in type 1 diabetes: multicenter data from Saudi Arabia. Presented at: American Diabetes Association 86th Scientific Sessions, June 19–22, 2026; abstract 1004-OR.
2. D’lessio DM, et al. The SURPASS-CVOT retinopathy substudy: retinal status after treatment with tirzepatide or dulaglutide in patients with type 2 diabetes and risk for progressive retinopathy. Presented at: American Diabetes Association 86th Scientific Sessions, June 19–22, 2026; abstract 1005-OR.
3. Gulaid F, Primo S, Higgins U, Chen J, Addison R, Lin Q. Bridging primary care and ophthalmology at Emory Health Care: a Phase 1 evaluation of AI retinal screening for diabetic retinopathy. Presented at: American Diabetes Association 86th Scientific Sessions, June 19–22, 2026; abstract 2720-LB.
4. Cooper B, et al. Influence of baseline diabetes severity on clinical and economic outcomes in faricimab-treated diabetic macular edema: linked analysis of administrative claims and IRIS Registry data. Presented at: American Diabetes Association 86th Scientific Sessions, June 19–22, 2026; abstract 1443-P.
5. Eblimit A, et al. Oral NLRP3 inhibitor BGE-102 preserves retinal vascular integrity in a preclinical model of diabetic retinopathy. Presented at: American Diabetes Association 86th Scientific Sessions, June 19–22, 2026; abstract 2719-LB.