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Fenofibrate slows diabetic retinopathy progression in at-risk patients
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Intensive treatment of glycemia and dyslipidemia slowed the progression of diabetic retinopathy in diabetic patients with cardiovascular disease or associated risk factors, according to study findings.
Data were culled from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, a collection of three randomized clinical trials designed to evaluate the effects of intensive blood glucose and blood pressure control and a combination of fenofibrate and statin vs. statin monotherapy therapy for dyslipidemia on the incidence of cardiovascular disease in patients with type 2 diabetes.
Researchers analyzed data from 2,856 patients. Eye examinations and fundus photography were conducted at baseline and at 4 years.
In the glycemia trial, the target of intensive treatment was hemoglobin A1c of less than 6% and the target of standard treatment was hemoglobin A1c of 7% to 9%.
In the blood pressure trial, the target of standard treatment was systolic blood pressure of less than 120 mm Hg and the target of intensive treatment was blood pressure of less than 140 mm Hg.
In the dyslipidemia trial, the researchers compared fenofibrate plus simvastatin with placebo plus simvastatin.
The researchers found that patients who received intensive glycemia and dyslipidemia treatment experienced statistically significant benefit, whereas no benefit was experienced from intensive blood pressure control.
Specifically, progression of retinopathy was slowed significantly among patients with a mean age of 62 years and mean diabetes duration of 10 years who had cardiovascular disease or cardiovascular risk factors and who underwent intensive glycemia treatment; however, the effects did not reach significance in patients with no retinopathy or in those with moderate to severe retinopathy, according to the researchers.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
Perspective
Back to TopNadia K. Waheed, MD, MPH
The Accord Eye study, a part of the larger ACCORD study, was a 4-year prospective study on 2,856 patients investigating the effect of intensive control of blood glucose, blood pressure and hyperlipidemia (with fenofibrate in addition to simvastatin) in reducing the development and progression of diabetic retinopathy in patients with diabetes and cardiovascular disease. In summary, for patients with mild to moderate nonproliferative diabetic retinopathy, intensive glycemic and hyperlipidemia control but not intensive hypertensive control resulted in a decreased rate of progression of the diabetic retinopathy. Intensive glycemic control, however, was associated with increased mortality. None of the interventions was shown to reduce development of diabetic retinopathy in patients who did not have it, reduce the risk of progression in patients who had severe nonproliferative or proliferative diabetic retinopathy, or reduce the risk of development and progression of diabetic macular edema.
This study has several advantages, including the large size and the extensive systemic data collected. Major drawbacks include the lack of OCT scanning to evaluate diabetic macular edema. The study also looked at a subgroup of patients who had cardiovascular risk factors or disease in addition to diabetes and therefore possibly selected for an older, sicker cohort of patients with a longer duration of diabetes, so the results are not generalizable to all diabetics and may have been skewed to show no significant effect of some of the interventions. However, the data adds to the already overwhelming evidence that better control of blood glucose and lipid levels may be associated with slower progression of diabetic retinopathy.
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