Effect of fibrates on glycemic parameters: A systematic review and meta-analysis of randomized placebo-controlled trials

Aims: The aim of this meta-analysis of randomized placebo-controlled clinical trials was to assess the effect of fibrates on glycemic parameters. Materials and methods: Only randomized placebo-controlled trials investigating the impact of fibrate treatment on glucose homeostasis markers were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases (from inception to April 11, 2017). A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on glycemic parameters. Results: This meta-analysis of data from 22 randomized placebo-controlled clinical trials involving a total of 11,402 subjects showed that fibrate therapy significantly decreased fasting plasma glucose (WMD: −0.28 mmol/L, 95% CI: −0.42, −0.14, p < 0.001), insulin levels (WMD: −3.87 pmol/L, 95% CI: −4.97, −2.78, p < 0.001) and insulin resistance (HOMA-IR, WMD: −1.09, 95% CI: −1.71, −0.47, p = 0.001), but with no effect on HbA1c (WMD: 0.01%, 95% CI: −0.18, 0.19, p = 0.955). All analyses were robust in the leave-one-out sensitivity analysis except for insulin levels that showed a non-significant result (WMD: −0.84 pmol/L, 95% CI: −6.36, 4.68, p = 0.766) following omission of one of the included trials. Conclusion: This meta-analysis has shown that fibrate treatment significantly decreases fasting plasma glucose, insulin levels, and HOMA-IR indicating additional clinical therapeutic benefits.