Pleiotropic effects of fenofibrate: Focus on type 2 diabetes mellitus

Abstract

Aims: The aim of the present study was to investigate the role of chronic low-grade inflammation in the development of the diabetic neuropathy and the possibility of its medical treatment with fenofibrate (145 mg/day). Materials and Methods. This trial included 60 patients with type 2 diabetes mellitus. The serum levels of several factors were measured: tumour necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), markers of oxidative stress (malondialdehyde levels), haemostasis, uric acid, glycaemic and lipid profile and the peripheral status (electromyography, total symptom score [TSS] and neuropathy impairment score in the lower limbs [NIS-LL]). Follow-up was at 24 weeks. Results. A significant negative correlation was found between the excitation rate of the sural nerve and levels of TNF, IL-6 and CRP (p <0.05). A number of changes were observed in the group of patients treated with fenofibrate (145 mg, daily) for 24 weeks: Levels of TNF decreased from 9.6±3.68 to 8.1±3.02 pg/ml (p <0.05), IL-6 decreased from 3.3±1.69 to 2.7±1.28 pg/ml (p <0.05), CRP decreased from 5.6±3.63 to 3.1±2.34 mg/l (p <0.05), thiobarbituric acid (TBARS) decreased from 3.1±089 to 2.6±1.21 mmol/l (p >0.05), uric acid decreased from 364±69.85 to 296.8±87.3 mmol/l (p <0.05) and fibrinogen decreased from 4.1±0.59 to 3.4±0.71 g/l (p <0.05). Improved levels of total cholesterol, triglycerides, HDL, VLDL and atherogenic index (p <0.05) were observed. Significantly increased M-wave in extensor digitorum brevis muscle was observed, from 5.25±2.31 to 6.3±3.14 mV (p <0.05). In addition, TSS changed from 9.55±1.53 to 7.28±1.26 (p <0.005) and NIS-LL changed from 10.12±2.05 to 8.24±1.68 (p <0.05). Conclusion. A correlation was found between EMG parameters and serum levels of inflammatory markers. Fenofibrate significantly reduced levels of inflammatory cytokines and improved lipid and purine metabolism as well as the function of the peripheral nervous system.