Effect Of Fibrates On Glucose Metabolism In Patients With Prediabetes And Insulin Resistance:a Meta-Analysis

BACKGROUNDHigh risk group of diabetes including patients with prediabetes and insulin resistance, such as metabolic syndrom, hypertension, obesity and dyslipidimia. Fibrates had showed some benefits of glucose metabolism for high risk group of diabetes except for modification of lifestyle, Metformin, Acabose and ACEIs. But there is no consensus whether fibrates treatment can improve glycemic control and insulin sensitivity and it is also unkown which group of patients can benefit more.OBJECTIVEThe meta-analysis was designed to assess the effect of fibrates on glucose metabolism for patient with prediabetes and insulin resistance, in order to provide additional evidence for further clinical researches.METHODWe searched the relative databases with time limited to March,2013. All RCTs about fibrates for high risk group of diabetes were included. Patients in the trial group were treated with fibrates, while those in the control group treated with placebo or receive diet treatment. Data extraction and assessment of trials were done by two independent authors. Review Manager5.0and Stata12.0were used for meta analysis.RESULT17trials involving1084patients were involved for the meta-analysis. Meta analysis showed that compared with placebo, fibrates can improve FPG、2hPG、FINS、 HOMA-IR and HbAlc. Subgroup analysis showed:(1) Compared with patients with normal glucose state, patients with glucose intolerance treated with fibrates can decrease FPG,2hPG, FINS and HbAlc significantly;(2) Fibrates can decrease FPG,2hPG and HbAlc significantly and it is better to be used for patients with hypertriglyceridemia;(3) Fibrates can decrease FINS and HOMA-IR significantly and it is better to be used for patients with mixed dyslipidemia;(4)Fenofibrate have better effect on decreasing FPG,2hPG, FINS and HOMA-IR than gemfibrozil and bezafibrate.CONCLUSIONCompared with placebo, fibrates can improve all the glucose metabolic markers in patients with prediabetes and insulin resistance. Patients with glucose intolerence may benefit more than with nomal glucose. Changes in glucose metabolism may be different for patients with hypertriglyceridemia and mixed dyslipidemia. Fenofibrate may have a better effect than other kinds of fibrates.