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

Morgan, Christopher Ll, Owens, David R, Aubonnet, Patrick, Carr, Emma S M, Jenkins-Jones, Sara, Poole, Chris D and Currie, Craig J 2013. Primary prevention of diabetic retinopathy with fibrates: a retrospective, matched cohort study. BMJ Open 3 (12) , e004025. 10.1136/bmjopen-2013-004025

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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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Publisher: BMJ Publishing Group
ISSN: 2044-6055
Date of Acceptance: 24 October 2013
Last Modified: 28 May 2020 13:50

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