Effect of diet and fenofibrate on lipid and glycaemic control in type 2 diabetes

Abstract

The effect of dietetic advice on hyperlipidaemia in type 2 diabetic patients is uncertain. We have investigated this modality of treatment in 50 type 2 diabetic patients (24 female), mean (±SD) age 54±4 years and diabetes duration 5±4 years. All had a random plasma total cholesterol concentration of >6.5 mmol/L (mean 7.5±0.7 mmol/L). Three months after dietetic intervention, cholesterol fell to 7.1±1.1 (p=0.049), but triglycerides, LDL‐cholesterol and HDL‐cholesterol were unchanged, as were HbA1c and body mass index (BMI). Thirteen (26%) patients reduced total cholesterol levels to <6.5 mmol/L on dietary treatment (‘diet responders’). In this group there were significant improvements in total cholesterol (6.9±0.3 versus 5.9±0.6, p=0.03) and LDL‐cholesterol (4.8±0.5 versus 4.1±0.5, p=0.003). This group had lower baseline total cholesterol levels than ‘diet non‐responders’. Multiple regression analysis revealed no association between diet response and baseline levels of HbA1c, BMI, age, sex, diabetes duration or compliance with dietetic advice. After two years of follow‐up only four of these 13 ‘diet responders’ had cholesterol levels<6.5 mmol/L without drug treatment. ‘Diet non‐responders’ at 3 months were treated with fenofibrate, which resulted in significant improvements in total cholesterol (7.6±0.9 before versus 6.8±1.1 after, p=0.012), LDL‐cholesterol (5.2±0.8 before versus 4.6±0.8 after, p=0.019) and triglycerides (3.7±2.7 before versus 2.7±1.4 after, p=0.008). HDL cholesterol rose (1.0±0.3 before versus 1.1±0.3 after, p=0.048), and HbA1c also fell from 7.5±1.9 to 6.9±1.8 (p=0.024) on fenofibrate treatment. We conclude that dietary treatment of dyslipidaemia in type 2 diabetes is effective only in a minority of patients, who are characterised by milder degrees of hypercholesterolaemia. Fenofibrate however was effective in improving dyslipidaemia, and was also associated with a reduction in HbA1c. Copyright © 2001 John Wiley & Sons, Ltd.