SGLT-2 Inhibitors and Retinal Pericyte Preservation: A Potential Direction in Diabetic Retinopathy Therapy

Pericyte loss is one of the earliest hallmark events in the pathogenesis of diabetic retinopathy (DR), leading to the formation of microaneurysms, disruption of the blood–retinal barrier, and capillary dropout. Recent preclinical studies suggest that sodium-glucose cotransporter 2 (SGLT-2) inhibitors may exert protective effects on retinal pericytes by reducing hyperglycemia-induced oxidative stress, inflammation, and cellular apoptosis. Furthermore, SGLT-2 inhibitors (SGLT-2Is) may attenuate the accumulation of advanced glycation end-products (AGEs) and improve endothelial–pericyte interactions. This chapter will explore current evidence and proposed mechanisms by which SGLT-2Is help preserve pericyte viability and function, potentially delaying DR onset and progression. Understanding this link may open new avenues for systemic interventions that target early microvascular damage in the retina.