Dataset Information

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

ABSTRACT:

Objectives

To compare the progression of diabetic retinopathy (DR) in people with type 2 diabetes treated with fibrates with that of non-exposed controls.

Design

Retrospective, matched cohort study.

Setting

UK Clinical Practice Research Datalink (CPRD).

Participants

5038 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 measures

The 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.

Results

Mean 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.

Conclusions

The treatment with fibrates in people with type 2 diabetes was independently associated with reduced progression to a first diagnosis of DR.

SUBMITTER: Morgan CL

PROVIDER: S-EPMC3855563 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Publications

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

Morgan Christopher Ll CL Owens David R DR Aubonnet Patrick P Carr Emma S M ES Jenkins-Jones Sara S Poole Chris D CD Currie Craig J CJ

BMJ open 20131203 12

<h4>Objectives</h4>To compare the progression of diabetic retinopathy (DR) in people with type 2 diabetes treated with fibrates with that of non-exposed controls.<h4>Design</h4>Retrospective, matched cohort study.<h4>Setting</h4>UK Clinical Practice Research Datalink (CPRD).<h4>Participants</h4>5038 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 ...[more]

PMID: 24302508

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Project description:Evidence from observational studies have found a relationship between serum cholesterol and diabetic retinopathy (DR). Apart of the assumption that cholesterolemic control has benefits for patients with diabetes with or without retinopathy, the effects of lipid-lowering drugs have not been properly mapped and critically assessed so far. The objective of this study was to evaluate the effects of statins and/or fibrates on prevention and progression of DR. We conducted a Systematic review of randomized controlled trials (RCTs) following the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. GRADE approach was used to summarize the certainty of the evidence. Eight RCTs that fulfilled our eligibility criteria were included, assessing the effects of fibrates (n?=?4), statins (n?=?3) and fibrate plus statins (n?=?1) for therapy (n?=?8) or prevention (n?=?4) of DR. Overall, the main concern regarding risk of bias assessment was due to incomplete outcome data because high rate of losses in five RCTs. Furthermore, the risk of reporting bias was rated unclear due the lack of previously published protocol in seven RCTs. Fibrates seemed to be associated with a 45% risk reduction of macular edema incidence (Relative Risk 0.55, 95% confidence interval of 0.38 to 0.81, 1309 participants, 2 RCTs, I2?=?0%, low certainty of the evidence). The certainty of evidence for other outcomes was also very low or low, and we are uncertain regarding the effects of fibrates for DR. Overall, adverse events seemed to be similar between fibrate and placebo, but again based on the width of the confidence intervals, an important increase of adverse events cannot be rule out. The combination statin/fibrate did not seem to have benefit for visual acuity but is likely that further studies can modify this estimate since the current evidence is limited. Adverse events and quality of life were not measured or reported. Concluding, this study found eight RCTs, with limited methodological quality, that assessed the effects of fibrates and/or statins for DR. Based on these findings, we are uncertain about the effects of statins for DR. Fibrates seemed to reduce the incidence of macular edema (low certainty evidence) without increase adverse events (low to very low certainty evidence). Number of Protocol registration PROSPERO CRD42016029746.

Dataset Information

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

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

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

Similar Datasets

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