Using lipid-lowering medication with fibrates, including fenofibrate and statins reduces not only the incidence of diabetic retinopathy in patients with Type 2 diabetes but also the need for treatment in those who already have the condition, a Japanese study finds.
Researchers at Osaka University Graduate School of Medicine in Japan analyzed data on almost 85,000 patients with Type 2 diabetes for their study.
Their results show that the incidence of diabetic retinopathy was reduced by about 23% with the use of lipid-lowering medication, and fibrates and statins were similarly effective.
They also found the need for diabetic retinopathy treatment among patients with Type 2 diabetes who already had the complication was reduced by 35% with lipid-lowering medication, and the need for laser photocoagulation and vitrectomy was reduced by 35% and 52%, respectively.
According to a
Medscape article, the results follow data from the ACCORD study, which showed that combining fenofibrate with a statin reduced the rate of progression of diabetic retinopathy, and an analysis of the FIELD study indicated that fenofibrate reduced the need for laser treatment of diabetic retinopathy.
The article also notes that the use of fenofibrate to slow the progression of existing diabetic retinopathy in people with Type 2 diabetes is to date only approved in Australia.
Study Design
Researchers gathered information from the health claims database of the Japan Medical Data Center, Tokyo, on adults with Type 2 diabetes or unspecified diabetes and a prescription for a glucose-lowering medication from 2005 to 2017.
They divided the claims into a baseline period of 2005 to 2013 and a follow-up period of 2014 to 2017.
The participants were divided into two groups: one that did not have diabetic retinopathy during the baseline period to determine the incidence of diabetic retinopathy during the follow-up period.69,070 individuals were reported in this group.
The second group consisted of individuals diagnosed with diabetic retinopathy during the baseline period. This group was recruited to determine the incidence of diabetic macular edema and the use of diabetic retinopathy-related treatments during the follow-up period.
Of the participants, 20.9% were prescribed standard statins, such as simvastatin and pravastatin, and 79.1% “strong” statins, which included atorvastatin and rosuvastatin. In addition, 54.4% were prescribed bezafibrate and 45.5% fenofibrate.
During the 3-year follow-up, 7110 individuals developed diabetic retinopathy. And lipid-lowering medication was associated with a significantly reduced incidence of diabetic retinopathy, with 7.4% of patients treated with the drugs developing the complication versus 11.4% of patients not treated.
Kawasaki says the study suggests that lipid-lowering medication is beneficial for both the incidence and progression of diabetic retinopathy, however, he notes the study was observational and limited to health claims data without clinical quantitative variables such as glucose level or severity of retinopathy.
Kawasaki says more research is needed on this promising topic.
Full research findings can be read here.
The study was supported by research grants provided by Novartis Pharma and Pfizer, Japan.
Sources:
1. “Statins, Fibrates Lower Diabetic Retinopathy Risks in Diabetes,” Davenport, Liam. September 28, 2018. Retrieved from: https://www.medscape.com/viewarticle/902675#vp_3
2. “Lipid‐lowering medication is associated with a decreased risk of diabetic retinopathy and the need for treatment in patients with type 2 diabetes: A real‐world observational analysis of a health claims database,” Ryo Kawasaki Ph.D., Tsuneo Konta Ph.D., Kohji Nishida Ph.D. First published: 22 May 2018. Retrieved: https://doi.org/10.1111/dom.13372