Statins and Fibrates for Diabetic Retinopathy: Protocol for a Systematic Review

Abstract

BackgroundDiabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus, and more than 75% of patients who have had diabetes for more than 20 years will have some degree of DR. This disease is highly destructive to self-esteem and puts a high burden on public health and pension systems due to the effects that it has on people of working age. The current mainstay of treatment is laser photocoagulation, which causes impairment of vision and discomfort to patients. Thus, finding a systemic drug that could act on all microcirculation and prevent direct manipulation of the eyes would be highly desirable.ObjectiveTo assess the efficacy and safety of the drugs in the statin and/or fibrate groups for the prevention and treatment of DR.MethodsIn this systematic review, we will select randomized controlled trials of fibrates or statins used for the treatment or prevention of DR. Our search strategy will include free text terms and controlled vocabulary (eg, MeSH, Emtree) for, “diabetic retinopathy”, “statins”, “fibrates”, “hypolipidemic agents”, and for drugs from both groups. Databases that will be used include Medical Literature Analysis and Retrieval System/PubMed, Embase, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Center on Health Sciences Information, Clinicaltrials.gov, World Health Organization International Clinical Trials Registry Platform, and OpenGrey, and we will not have language or date limits. Two review authors will independently select eligible studies and assess the risk of bias using the Cochrane Collaboration’s tool. We will report structured summaries of the included studies and, if possible, conduct meta-analyses.ResultsThis is a protocol for a systematic review, therefore results are not available. We registered a short version of this protocol before progressing in the review and we are currently in the process of selecting the studies for inclusion.ConclusionsIntensive glucose control and lowering blood pressure and lipids are mechanisms that protect macrocirculation in diabetic patients. Both macrovascular and microvascular events in diabetic patients appear to have a common pathway, starting with endothelial injury. Thus, prevention and treatment of microvascular events may benefit from the same interventions. In the review for which we have written this protocol, we will assess whether the use of lipid-lowering oral drugs of the statin and/or fibrate groups may prevent and/or retard progression of DR, with the added benefit of preserving visual acuity.Trial RegistrationPROSPERO CRD42016029746

Statins and/or fibrates for diabetic retinopathy: a systematic review and meta-analysis

“…The manuscript was prepared in accordance to the recommendations of Preferred Reporting Itens for Systematic Reviews and Meta - analysis (PRISMA) [16]. The protocol was published prospectively [17] and registered in PROSPERO database ( http://www.crd.york.ac.uk/PROSPERO/ ) under the number CRD42016029746. This study was conducted at the Evidence-based Healthcare Post-graduation Program of Universidade Federal de São Paulo.…”

A Mediterranean Diet May Be Protective in the Development of Diabetic Retinopathy

“…Regulation of HbA1c and blood pressure is the primary goal of DR management. However, reducing serum lipid levels and fighting obesity are among other concerns [ 16 , 17 , 18 ]. These goals may be accomplished through prophylactic examinations, thus achieving earlier diagnosis and tailoring the therapy to individual patients.…”

The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy—A Review of the Literature

“…When DR is in its early stage, the risk of vision loss is low and the only treatment that can be offered is to control the risk factors associated with the development and progression of this disorder. DR control aims primarily to regulate HbA1c and blood pressure, but also to reduce serum lipid levels and fight obesity [ 13 , 14 , 15 ]. This can be accomplished by conducting prophylactic examinations in order to diagnose the disease early and to tailor the therapy to individual patients, and above all by promoting a healthy lifestyle that can significantly affect the course of the disease.…”