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Der Diabetologe

, Volume 15, Issue 1, pp 39–42 | Cite as

Relevanz von Fibraten in der Diabetestherapie

  • Gerald KloseEmail author
Leitthema
  • 64 Downloads

Zusammenfassung

Fibrate wirken auf die bei Typ-2-Diabetes (T2DM) typische Dyslipidämie besonders gut. Im Gegensatz zu der die Leitlinienempfehlungen begründenden Evidenz für Statine, die nahezu ausschließlich die LDL-Cholesterin-Werte (LDL: „low density lipoprotein“) senken, ist die bisherige RCT-Outcomeevidenz (RCT: randomisierte kontrollierte Studie) für Fibrate jedoch gering. Da höhere Triglyzeridspiegel bei T2DM-Patienten auch unter Statinbehandlung weiter mit einer Erhöhung des kardiovaskulären Risikos verbunden sind, stellt sich die Frage eines evtl. doch vorhandenen, nur nicht adäquat geprüften Zusatznutzens der Fibrate bei diabetischer Dyslipidämie. So fand sich in Subgruppenanalysen bereits konsistent eine signifikante positive Outcomeevidenz für Fibrate bei denjenigen Patienten, deren Triglyzeridwerte über 200 mg/dl lagen. Für die Bewertung der praktischen Relevanz von unter Fenofibrat beobachteten Verbesserungen nichtkardiovaskulärer Endpunkte, nämlich Retinopathie und Minoramputationen, sind weitere Studien erforderlich. Zu zukünftigen Entwicklungen gehört ein neuartiger selektiver PPARα-Aktivator (PPAR: peroxisomenproliferatoraktivierter Rezeptor), Pemafibrat (K-877). Die diesbezüglichen Ergebnisse in der Outcomestudie PROMINENT („pemafibrate to reduce cardiovascular outcomes by reducing triglycerides in patients with diabetes“) werden weitere Antworten zur Relevanz von Fibraten geben.

Schlüsselwörter

Dyslipidämie Fibrinsäuren Triglyzeride Diabetische Retinopathie Pemafibrate 

The relevance of fibrates in the treatment of diabetes

Abstract

Fibrates act on the typical dyslipidemia-findings in type 2 diabetes mellitus (T2DM). However, in contrast to the guideline recommendation-based evidence for statins that almost exclusively reduce low-density lipoprotein (LDL) cholesterol, the current randomized controlled trial (RCT) outcome evidence for fibrates is low. Since higher triglycerides in T2DM patients continue to be associated with an increase in cardiovascular risk even under statin treatment, the question arises of possibly existing, but not adequately tested added benefit of fibrates in diabetic dyslipidemia. Subgroup analyzes consistently showed a significant positive outcome for fibrates in patients whose triglycerides were above 200 mg/dl. Further studies are needed to assess the practical relevance of improvements in non-cardiovascular endpoints observed under fenofibrate, namely retinopathy and minor amputations. Future developments include a novel selective peroxisome proliferator activated receptor (PPARα), pemafibrate (K-877). Its results in the Outcome Trial PROMINENT (pemafibrate to reduce cardiovascular outcomes by reducing triglycerides in patients with diabetes) will provide further answers on the relevance of fibrates.

Keywords

Dyslipidemia Fibric acids Triglycerides Diabetic retinopathy Pemafibrat 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

G. Klose gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Endokrinologie BremenBremenDeutschland

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