The Pages section of Primary Care Notebook comprises more than 30,000 concise, interlinked clinical reference articles, each focused on a specific primary care topic.
low-dose triple-pill vs standard-care protocols for hypertension treatment in Nigeria
paternal metformin use and risk of congenital malformations in offspring
back-up antibiotic prescribing - principles for sore throat, acute cough, acute otitis media, simple lower UTI in non-pregnant women
intrauterine contraceptive (progestogen) and breast cancer risk
Bright light therapy in seasonal and nonseasonal depressive disorders
Despite not being recommended by NICE as a routine option to lower lipids in people with diabetes, fenofibrate has recently been approved by NICE as an option to reduce the progression of retinopathy in people with type 2 diabetes and early (that is, non-proliferative) diabetic retinopathy (an off-label use).
What is the basis of this apparent conundrum?
Fibrates are a class of lipid-modifying medications that increase HDL-cholesterol and reduce triglycerides. Various randomised controlled trials in the 2000s demonstrated no significant benefit for fibrates in preventing cardiovascular outcomes. As such, fibrates are not a first-line cholesterol-lowering medication.
One lipid-modification study called FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) did, however, yield a signal that fenofibrate may reduce the risk of progression of diabetic retinopathy in patients with type 2 diabetes.
This has been followed by a placebo-controlled, randomised study called LENS (Lowering Events in Non-proliferative Retinopathy in Scotland), published earlier this year, which demonstrated a >25% reduced risk of worsening eye status among patients with diabetes using fenofibrate.
For more information, see Primary Care Notebook.
Other highlights in this month’s email relate to meningioma and progestogens, laughter therapy in the management of dry eyes and plasma phospho-tau217 in Alzheimer's disease (AD).
Since 2001, GPnotebook has been a "go-to" clinical reference source for busy primary care professionals seeking quick answers to clinical queries
Written by practising GPs, GPnotebook comprises more than 30,000 pages of clinical reference material, with each article focused on a specific primary care topic
Information is organised into short, easy-to-read articles – quick enough to use during consultations. Hundreds of updates every month
As well as the written reference material, we have a growing library of video and podcast content, along with educational modules and quizzes to support learning and personal development