ADA: Fibrates and Statins Keep Diabetic Neuropathy at Bay

CHICAGO, June 27 -- Statins can cut the risk of peripheral neuropathy from type 2 diabetes by a third, and fibrates can do it by nearly half, reported Australian investigators here.
Among nearly 1,300 patients with type 2 diabetes who were part of a longitudinal study, statins were associated with reduced risk of peripheral sensory neuropathy by 35%, and fibrates by 45%, said Timothy Davis, M.D., Ph.D., of the University of Western Australia, in Perth.
The reduced risk associated with the two lipid-lowering classes should be considered comparable, because of the wide confidence intervals involved, said Dr. Davis at the American Diabetes Association meeting here.
Dr. Davis and colleagues conducted a cross-sectional study of 1,294 patients enrolled in the Fremantle Diabetes Study, a five-year prospective study, and also evaluated 531 patients in the study who had attended six comprehensive annual assessments.
They defined neuropathy as a score greater than two out of eight on the clinical portion of the Michigan Neuropathy Screening Instrument, which, according to Dr. Davis, is among the most sensitive and specific of the clinical screening tools.
The mean age of the patients in the cross-sectional sample was 64.1+11.3 years and 48.8% were men. The median duration since diagnosis was 4.0 (range 1.0-9.0) years, and 30.9% of the patients had peripheral neuropathy.
In all, 3.5% of the patients used fibrates -- gemfibrozil (Lopid) at study outset, and later fenofibrate (Lofibra) -- and 6.8% used statins, including atorvastatin (Lipitor), simvastatin (Zocor), and pravastatin (Pravachol).
The authors found that in logistic regression analyses, many different factors were independently and positively associated (P<0.03) with prevalent peripheral neuropathy at baseline. These factors included sociodemographics, older age, longer diabetes duration, central adiposity, increasing height, higher fasting plasma glucose, systolic blood pressure, ratio of urinary albumin to creatinine, and ethnic-racial background.
In contrast, the use of fibrate therapy was negatively associated with neuropathy (odds ratio 0.30 (95% confidence interval, 0.10-0.86, (P=0.025).
Among the patients in the longitudinal substudy, the use of fibrates increased to 10.4% over five years, and the use of statins grew to 36.5%. Among these patients, the time to new peripheral neuropathy was associated with longer use of both fibrates (hazard ratio 0.52, 95% CI, 0.27-0.98) and statins (hazard ratio 0.65, 95% CI, 0.46-0.93), and both associations were significant (P<0.042).
Neither study funding nor author conflicts of interest were disclosed.Primary source: American Diabetes Association 2007 Scientific SessionsSource reference: Davis T et al. "Lipid-lowering Therapy Protects Against Peripheral Sensory Neuropathy in Type 2 Diabetes." Abstract 0004 , presented June 22.