Results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were reported in this month’s Diabetes Special Issue of The Lancet. University of Sydney researchers evaluated the risk of cardiovascular death and amputation in type 2 diabetics using the medication fenofibrate. Over a five year period, 9,795 diabetics ages 50 to 75 were given 200 mg of fenofibrate daily or a placebo. The clinicians were blinded to the treatment allocation. There was no difference between the two groups in the rate of cardiovascular death, but diabetics taking fenofibrate had a 36% lower risk of amputation, particular minor amputations occurring below the ankle. There was also an association between cardiovascular disease, microvascular disease, previous amputation history, history of ulceration, smoking, longer duration of diabetes and those who had amputations during the study period.
Fenofibrate is mainly used to reduce cholesterol levels in patients at risk of cardiovascular disease. It has been shown to reduce both low-density lipoprotein (LDL) and triglycerides and increase high-density lipoprotein (HDL). Fenofibrate acts by reducing the synthesis of cholesterol and enhancing it’s elimination. Fenofibrate has been previously shown to reduce overall cardiovascular events, as well as improve some microvascular complications in type 2 diabetics.
One in ten diabetics in the United States will require an amputation at some point during their life. In 2004, approximately 71,000 nontraumatic lower-limb amputations were performed in people with diabetes. Some common risk factors associated with amputation include peripheral neuropathy, large and small vessel disease and foot ulceration. One in four diabetics with an ulceration will have a lower extremity amputation. More information on diabetes and foot ulcerations.
Rajamani K et al. Effect of fenofibrate on amputation events in people with type 2 diabetes mellitus (FIELD study): a prespecified analysis of a randomised controlled trial. The Lancet, Volume 373, Issue 9677, Pages 1780 – 1788, 23 May 2009.
Study was funded by Solvay Pharmaceuticals
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