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Bezafibrate Can Prevent or Delay Type 2 Diabetes

Bezafibrate, a pan-PPAR agonist used widely for treating dyslipidemia in the UK, appears to prevent or delay the development of Type 2 diabetes, according to results of a retrospective study.

“If prospective trials bear out these retrospective findings, bezafibrate could become an oral antidiabetic that also reduces cardiovascular risk,” Dr. James H. Flory told Reuters Health.

Dr. Flory, from the University of Pennsylvania School of Medicine, Philadelphia, and colleagues used observational data from the UK’s General Practice Research Database to examine their a priori hypothesis that bezafibrate is unique among fibrates in reducing diabetes risk. The cohort included 12,161 patients on bezafibrate and 4,191 who took other fibrates.
The incidence of Type 2 diabetes among bezafibrate users was 8.5 cases per 1,000 patient-years, the authors report, compared with 14.4 cases per 1,000 patient years among users of other fibrates.

In a fully adjusted model, the hazard ratio for incident Type 2 diabetes was 0.66 for bezafibrate users compared with users of other fibrates.

Moreover, the investigators note, the risk of developing diabetes decreased monotonically as the duration of bezafibrate therapy increased.

Among patients with preexisting diabetes, bezafibrate use was associated with a significantly lower risk of progression to antidiabetic medication use and with a trend toward a lower risk of progression to insulin therapy, compared with use of other fibrates.

“I do think that at least one prospective randomized controlled trial is needed before bezafibrate can be indicated to prevent or treat diabetes,” Dr. Flory said. “This is especially true in the United States, where bezafibrate is not even on the market.”
He added, “Right now it is not clear that any of the available diabetes medications are safe from a cardiovascular standpoint. And bezafibrate would be cheap because it is off patent, but because it is off patent industry is not likely to take care of this research for us.”

Diabetes Care April 2009;32:547-551.

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