# Delphi Consensus on the Use of Fenofibrate as Systemic Therapy for the Prevention of Diabetic Retinopathy Progression

## TL;DR

Experts agree that early use of fenofibrate can help prevent diabetic retinopathy from worsening and recommend better coordination in patient care.

## Contribution

A global Delphi consensus provides unified, evidence-based recommendations for using fenofibrate in diabetic retinopathy management.

## Key findings

- Early and sustained fenofibrate use is recommended to slow retinopathy progression.
- A transient rise in serum creatinine from fenofibrate is not a sign of kidney damage.
- Multidisciplinary care and patient education are emphasized to improve outcomes.

## Abstract

Diabetic retinopathy remains a leading cause of preventable blindness worldwide, yet screening and management practices vary widely. Evidence suggests that systemic therapies, including fenofibrate, may slow diabetic retinopathy progression, but their use is inconsistent across clinical settings. This study aimed to establish an evidence‐informed consensus among endocrinology experts on the screening, diagnosis, and treatment of diabetic retinopathy, with a particular focus on recommendations for the use of systemic therapy to prevent disease progression.

A modified three‐round Delphi process was conducted with 19 endocrinology experts from diverse geographic regions. A core panel of 10 experts and an extended panel of 9 reviewed and rated 19 evidence‐based statements. Consensus was defined as > 75% agreement.

All 19 statements achieved consensus, with 14 receiving > 80% agreement. The panel endorsed frequent diabetic retinopathy screening based on diabetes type and risk level, early initiation of fenofibrate in patients with mild to moderate non‐proliferative diabetic retinopathy, and continued therapy to sustain retinal protection. Fenofibrate was recognized for its pleiotropic effects, and the experts agreed that the transient rise in serum creatinine with fenofibrate is not indicative of renal damage and should not prompt discontinuation.

This consensus highlights the need for multidisciplinary care, coordinated pathways, and patient education in diabetic retinopathy care. It also offers unified, evidence‐informed recommendations for endocrinologists for the early initiation of fenofibrate to reduce diabetic retinopathy progression. While further studies are needed, these findings offer a practical framework for improving diabetic retinopathy management globally.

Nineteen endocrinology experts from nine countries participated in a Delphi consensus on systemic therapy for diabetic retinopathy.Consensus supported early and sustained use of fenofibrate to slow retinopathy progression and reduce invasive interventions.Experts emphasized coordinated multidisciplinary care and patient education to optimize outcomes globally.

Nineteen endocrinology experts from nine countries participated in a Delphi consensus on systemic therapy for diabetic retinopathy.

Consensus supported early and sustained use of fenofibrate to slow retinopathy progression and reduce invasive interventions.

Experts emphasized coordinated multidisciplinary care and patient education to optimize outcomes globally.

Nineteen international endocrinologists support fenofibrate use to prevent diabetic retinopathy progression and emphasize the need for coordinated care pathways and early intervention to improve diabetic retinopathy management globally.