Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies

Eye (Lond). 2011 Jul;25(7):843-9. doi: 10.1038/eye.2011.62. Epub 2011 Mar 25.

Abstract

The approach of all ophthalmologists, diabetologists and general practitioners seeing patients with diabetic retinopathy should be that good control of blood glucose, blood pressure and plasma lipids are all essential components of modern medical management. The more recent data on the use of fenofibrate in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye studies is reviewed. In FIELD, fenofibrate (200 mg/day) reduced the requirements for laser therapy and prevented disease progression in patients with pre-existing diabetic retinopathy. In ACCORD Eye, fenofibrate (160 mg daily) with simvastatin resulted in a 40% reduction in the odds of retinopathy progressing over 4 years, compared with simvastatin alone. This occurred with an increase in HDL-cholesterol and a decrease in the serum triglyceride level in the fenofibrate group, as compared with the placebo group, and was independent of glycaemic control. We believe fenofibrate is effective in preventing progression of established diabetic retinopathy in type 2 diabetes and should be considered for patients with pre-proliferative diabetic retinopathy and/or diabetic maculopathy, particularly in those with macular oedema requiring laser.

Publication types

  • Review

MeSH terms

  • Adult
  • Blood Pressure / physiology
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Retinopathy / blood
  • Diabetic Retinopathy / drug therapy*
  • Diabetic Retinopathy / physiopathology
  • Female
  • Fenofibrate / therapeutic use*
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypolipidemic Agents / therapeutic use*
  • Lipids / blood
  • Middle Aged
  • Simvastatin / therapeutic use

Substances

  • Glycated Hemoglobin A
  • Hypolipidemic Agents
  • Lipids
  • hemoglobin A1c protein, human
  • Simvastatin
  • Fenofibrate