Primary prevention of diabetic retinopathy with fibrates: a retrospective, matched cohort study

Abstract

ObjectivesTo compare the progression of diabetic retinopathy (DR) in people with type 2 diabetes treated with fibrates with that of non-exposed controls.DesignRetrospective, matched cohort study.SettingUK Clinical Practice Research Datalink (CPRD).Participants5038 people with type 2 diabetes with a history of fibrate exposure but without evidence of DR were identified. Three thousand one hundred and seventy-six (63%) people could be randomly matched to one non-exposed control; of these, 2599 (81.8%) were matched without any missing blood pressure or glycated haemoglobin (HbA1c) values.Main outcome measuresThe primary endpoint was first recorded DR with a secondary endpoint of all-cause mortality or first DR. Time to clinical endpoints was compared using Cox proportional hazards models.ResultsMean follow-up was 5.1 and 5.0 years for fibrate-exposed and non-exposed patients, respectively. For fibrate-exposed participants, there was a reduction in DR: 33.4 events/1000 person-years vs 40.4 (p=0.002), and in death or DR: 50.6 vs 60.2 (p<0.001). For those matched with full systolic blood pressure and HbA1c data, crude event rates were 34.3 versus 43.9 for DR (p<0.001) and 51.2 vs 63.4 (p<0.001) for death or DR. Following adjustment, DR was significantly delayed for those treated with fibrates, with an adjusted HR (aHR) of 0.785 (p<0.001) for participants with complete data and an aHR of 0.802 (p<0.001) for all participants.ConclusionsThe treatment with fibrates in people with type 2 diabetes was independently associated with reduced progression to a first diagnosis of DR.

Vascular Complications of Diabetes

“…46 A subsequent retrospective evaluation similarly found a 22% reduction in diabetic retinopathy with fibrate treatment. 47 …”

How to prevent the microvascular complications of type 2 diabetes beyond glucose control

“…More recently, a large British retrospective cohort study compared the progression to diabetic retinopathy in patients with type 2 diabetes who were exposed or not exposed to fenofibrate. 51 The study included 5038 patients from 700 practices followed for five years and showed a reduction of diabetic retinopathy in those exposed to fibrates (33.4 v 40.4 events/1000 person years; P=0.002). Limitations were related to the retrospective design, but results supported a role for fenofibrate in primary prevention.…”

Residual Microvascular Risk in Type 2 Diabetes in 2014: Is it Time for a Re-Think? A Perspective from the Residual Risk Reduction Initiative (R3i)

“…First, are these effects specific to fenofibrate or do they relate to fibrates more generally? Indeed, findings from a recent study in a real-world setting (n=5,038 type 2 diabetes patients) indicate that fibrate treatment (including bezafibrate, fenofibrate, ciprofibrate or gemfibrozil) was independently associated with reduction in progression to first retinopathy (primary outcome) [45]. Both bezafibrate (n=1739) and fenofibrate (n=1413) were the most commonly prescribed fibrates in this study (for a mean of 2.1 and 2.8 years, respectively).…”