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This month's highlights

Dr Jim McMorran BM BCh PhD DCH DRCOG MRCGP FRCGP

Despite not being recommended by NICE as a routine option to lower lipids in people with diabetes, fenofibrate has recently been approved by NICE as an option to reduce the progression of retinopathy in people with type 2 diabetes and early (that is, non-proliferative) diabetic retinopathy (an off-label use).

What is the basis of this apparent conundrum?

Fibrates are a class of lipid-modifying medications that increase HDL-cholesterol and reduce triglycerides. Various randomised controlled trials in the 2000s demonstrated no significant benefit for fibrates in preventing cardiovascular outcomes. As such, fibrates are not a first-line cholesterol-lowering medication.

One lipid-modification study called FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) did, however, yield a signal that fenofibrate may reduce the risk of progression of diabetic retinopathy in patients with type 2 diabetes.

This has been followed by a placebo-controlled, randomised study called LENS (Lowering Events in Non-proliferative Retinopathy in Scotland), published earlier this year, which demonstrated a >25% reduced risk of worsening eye status among patients with diabetes using fenofibrate.

For more information, see GPnotebook.

Other highlights in this month’s email relate to meningioma and progestogens, laughter therapy in the management of dry eyes and plasma phospho-tau217 in Alzheimer's disease (AD).

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