The anti-cholesterol drug fenofibrate appears to reduce risks of amputation for diabetics by as much as 36 percent, a study has found.

The study was published by The Lancet in a special edition on diabetes, which included another study on how rigorous monitoring and control of blood sugar reduces heart attacks.

In the first study, researchers in Australia ran a 5-year trial involving 9,795 diabetic patients. 4,895 of them were given fenofibrate, produced by Belgian drugs maker Solvay, while the rest were given a placebo.

By the end of the trial, 115 patients had had lower-limb amputations. The risk of first time amputation was 36 percent lower for patients given fenofibrate compared with a placebo.

“Treatment with fenofibrate was associated with a lower risk of amputations, particularly minor amputations (below the ankle),” wrote the team, led by Anthony Keech and Kushwin Rajamani at the National Health and Medical Research Council Clinical Trials Center, University of Sydney, Australia.

“These findings could lead to a change in standard treatment for the prevention of diabetes-related lower-limb amputations.”

An amputation due to diabetes occurs every 30 seconds around the world and imposes a huge burden not only on the victims and their families, but healthcare systems too.

High blood sugar can damage nerves and blood vessels in the lower extremities that can lead to gangrene. Severe damage might require toe, foot or even leg amputation.

RIGOROUS SUGAR CONTROL

In the second study, researchers trawled through 5 previous studies to show that intensive glucose control in diabetics leads to fewer heart attacks, but has no significant effect on stroke or death from all other causes.

To date, individual studies of glucose control have failed to show consistent benefits and some even suggested possible harm.

The five studies, analyzed by a team headed by Kausik Ray of Britain’s University of Cambridge, involved 33,000 patients and provided information on 1,497 heart attacks, 2,318 counts of coronary heart disease, 1,127 strokes, and 2,892 deaths.

Patients given more drugs to control their blood sugar had a 15 percent reduction in heart attacks. But such intense treatment had no effect on stroke rates or other causes of death.

“Overall, intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death,” the researchers wrote.

A third study on women with gestational diabetes during pregnancy found that they have a far higher risk of developing permanent diabetes after giving birth.

Gestational diabetes (GD) is glucose intolerance first detected during pregnancy. After birth, the woman’s blood sugar control is restored to pre-pregnancy levels, but some remain at high risk of diabetes in future.

In this study, researchers at the University College London and London School of Hygiene and Tropical Medicine analysed 20 studies involving a total of 675,000 women, of whom 10,859 developed diabetes.

Women with GD were around 7.5 times more likely to develop diabetes after pregnancy compared to those with normal blood sugar control during pregnancy, they found.

“This should act as an incentive for women to attend the recommended post-birth check,” they wrote.

“This attendance could be an opportunity to provide advice on diet and exercise, and treatments to delay or prevent onset of diabetes, as well as alerting these women to symptoms of future diabetes, and to alert general practitioners responsible for their long-term care.”

By Tan Ee Lyn
HONG KONG (Reuters)