Bezafibrate Slows Onset of Diabetes in Obese Individuals

Treatment with the fibric acid derivative bezafibrate, which influences primary lipid metabolism, reduces the incidence and delays the onset of type 2 diabetes in obese patients.

In an earlier study, Dr. Alexander Tenenbaum and colleagues observed that bezafibrate reduced the incidence of diabetes in patients with impaired fasting glucose levels. Theorizing that this effect would be present in obese individuals with normal fasting glucose levels as well, the investigators randomized 339 non-diabetic obese patients to 400 mg bezafibrate or placebo once daily.

Ninety-eight developed diabetes over a median of 6.3 years. Diabetes developed in 56 (37.0%) of placebo-treated versus 42 (27.1%) of bezafibrate-treated patients, the researchers report in the October issue of the European Heart Journal.

The median time to onset of diabetes was significantly longer in the bezafibrate group compared with the placebo group (4.0 vs 2.0 years; p = 0.002). In multivariate analysis, bezafibrate therapy was an independent predictor of reduced risk of new diabetes with a hazard ratio of 0.59.

Dr. Tenenbaum from Chaim Sheba Medical Center in Tel-Hashomer said that, obesity has reached "epidemic dimensions worldwide" and is clearly associated with metabolic syndrome and type 2 diabetes.

"Our study has shown that bezafibrate can reduce the incidence of type 2 diabetes with a magnitude of benefit even better than other medications (41% reduction during about 6 years)," he said. "Moreover, bezafibrate also delayed the onset of diabetes by about 2 years."

"It seems logical," Dr. Tenenbaum continued, that combining bezafibrate with other drugs, such as angiotensin-converting enzyme inhibitors, statins and metformin, might achieve even better results.

Bezafibrate is a nonselective activator for nuclear peroxisome proliferator activated receptors (PPAR) with triglyceride-lowering and HDL-cholesterol raising effects resulting in decreased systemic availability of fatty acid and improvement of insulin sensitization.

The current study, Dr. Tenenbaum concluded, "reinforces the argument that management of atherogenic dyslipidemia in patients with obesity, metabolic syndrome and/or type 2 diabetes should be focused not just on LDL cholesterol, but on triglycerides and HDL cholesterol as well."
Euro Heart J 2005;26:2032-2038.

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