Abstract
Lim et al. 1 have provided a comprehensive review of the prevention and treatment of diabetic foot ulcers. The possible role of fibrate drugs in the prevention of diabetic foot ulcers was not mentioned. In the Fenofibrate Intervention and Event Lowering in Diabetes study, 2 the effects of long-term fenofibrate therapy on cardiovascular events in 9795 type 2 diabetic participants were assessed over five years. Fenofibrate did not significantly reduce the risk of the primary outcome measure of major coronary events, but it reduced the risk of non-fatal myocardial infarction and coronary revascularisation. In addition, the rate of albuminuria progression was reduced as was the need for laser therapy for diabetic retinopathy. The effects on retinopathy progression were confirmed in the Action to Control Cardiovascular Risk in Diabetes eye study. 3
A subsequent prespecified analysis of Fenofibrate Intervention and Event Lowering in Diabetes 4 reported on the effect of fenofibrate on lower limb amputation events and on the differential effects on major and minor amputations with and without associated large vessel disease. Major amputations were defined as those above the knee and minor amputations as those below the ankle. The risk of a first non-traumatic amputation was significantly lower in the fenofibrate group. This was due to a significant reduction in the risk of minor amputation in those without large vessel disease. This group had a higher incidence of neuropathy at baseline than those who had amputations associated with large vessel disease. The risk of major amputations did not differ between the two groups.
In the Fenofibrate Intervention and Event Lowering in Diabetes study, fenofibrate was well tolerated and had a good safety profile irrespective of concomitant therapy. It therefore seems likely that fenofibrate could have a role in preventing diabetic neuropathic ulcers in those at risk and has the added benefit that it may slow the progression of albuminuria and diabetic retinopathy.