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August 8, 1990, Vol 264, No. 6 >
ARTICLE | August 8, 1990

Nicotinic Acid as Therapy for Dyslipidemia in Non—Insulin-Dependent Diabetes Mellitus FREE

Abhimanyu Garg, MBBS, MD; Scott M. Grundy, MD, PhD
[+] Author Affiliations

Reprint requests to Center for Human Nutrition, 5323 Harry Hines Blvd, Dallas,TX 75235-9052(DrGrundy).


JAMA. 1990;264(6):723-726. doi:10.1001/jama.1990.03450060069031
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References

Recently, nicotinic acid has been recommended as a first-line hypolipidemic drug. To determine the effectiveness of nicotinic acid in dyslipidemic patients with non—insulin-dependent diabetes mellitus, 13 patients were treated in a randomized crossover trial. Patients received either nicotinic acid (1.5 g three times daily) or no therapy (control period) for 8 weeks each. Compared with the control period, nicotinic acid therapy reduced the plasma total cholesterol level by 24%, plasma triglyceride level by 45%, very-low-density lipoprotein cholesterol level by 58%, and low-density lipoprotein cholesterol level by 15% and it increased the high-density lipoprotein cholesterol level by 34%. However, nicotinic acid therapy resulted in the deterioration of glycemic control, as evidenced by a 16% increase in mean plasma glucose concentrations, a 21% increase in glycosylated hemoglobin levels, and the induction of marked glycosuria in some patients. Furthermore, a consistent increase in plasma uric acid levels was observed. Therefore, despite improvement in lipid and lipoprotein concentrations, because of worsening hyperglycemia and the development of hyperuricemia, nicotinic acid must be used with caution in patients with non—insulin-dependent diabetes mellitus with dyslipidemia. We suggest that the drug not be used as a first-line hypolipidemic drug in patients with non—insulin-dependent diabetes mellitus.

(JAMA. 1990;264:723-726)

REFERENCES

1 +
Stern MP, Patterson JK, Haffner SM, Hazuda HP, Mitchell BD.  Lack of awareness and treatment of hyperlipidemia in type II diabetes in a community survey . JAMA. 1989;;262:360-364.
2 +
Barrett-Connor E, Orchard T.  Diabetes and heart disease . In: National Diabetes Data Group. Diabetes in America: Diabetes Data Compiled 1984 . Washington DC, US Dept of Health and Human Services; 1985;:chap 16. National Institutes of Health publication 85-1468.
3 +
National Cholesterol Education Program Expert Panel, National Heart Lung and Blood Institute.  Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med. 1988;;148:36-69.
4 +
National Diabetes Data Group.  Classification and diagnosis of diabetes mellitus and other categories of glucose tolerance . Diabetes. 1979;;28:1039-1057.
5 +
American Diabetes Association.  Nutritional recommendations and principles for individuals with diabetes mellitus: 1986 . Diabetes Care. 1987;;10:126-132.
6 +
Blankenhorn DM, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA. 1987;;257:3233-3240.
7 +
Manual of Laboratory Operations: Lipid Research Clinics Program: Lipid and Lipoprotein Analysis . 2nd ed. Washington, DC: US Dept of Health and Human Services; 1982;.
8 +
Roeschlau P, Bernt E, Gruber W.  Enzymatische Bestimmung gesamt-cholesterins im Serum . Z Klin Chem Klin Biochem. 1974;;12:226.
9 +
Wahlefeld AW.  Triglyceride determination after enzymatic hydrolysis . In: Bergmeyer HU, ed. Methods of Enzymatic Analysis . Orlando, Fla: Academic Press Inc; 1974;;4:1831-1835.
10 +
Zar JH. Biostatistical Analysis. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall International Inc; 1984;:222-225.
11 +
Winer BJ. Statistical Principles in Experimental Design. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1971;:261-308.
12 +
Altschul R, Hoffer A, Stephen JD.  Influence of nicotinic acid on serum cholesterol in man . Arch Biochem Biophys. 1955;;54:558-559.
13 +
Gurian H, Adlersberg D.  The effect of large doses of nicotinic acid on circulating lipids and carbohydrate tolerance . Am J Med Sci. 1959;;237:12-22.
14 +
Gaut ZN, Pocelinko R, Solomon HM, Thomas GB.  Oral glucose tolerance, plasma insulin, and uric acid excretion in man during chronic administration of nicotinic acid . Metabolism. 1971;;20:1031-1035.
15 +
Miettinen TA, Taskinen M-R, Pelkonen R, Nikkila EA.  Glucose tolerance and plasma insulin in man during acute and chronic administration of nicotinic acid . Acta Med Scand. 1969;;186:247-253.
16 +
Parsons WB Jr.  Studies of nicotinic acid use in hypercholesterolemia: changes in hepatic function, carbohydrate tolerance and uric acid metabolism . Arch Intern Med. 1961;;107:85-99.
17 +
Molnar GD, Berge KG, Rosevear JW, McGuckin WF, Achor WP.  The effect of nicotinic acid in diabetes mellitus . Metabolism. 1964;;13:181-189.
18 +
Vega GL, Grundy SM.  Gemfibrozil therapy in primary hypertriglyceridemia associated with coronary heart disease: effects on metabolism of low-density lipoproteins . JAMA. 1985;;253:2398-2403.
19 +
Garg A, Grundy SM.  Gemfibrozil alone and in combination with lovastatin for treatment of hypertriglyceridemia in NIDDM . Diabetes. 1989;;38:364-372.
20 +
Simons LA, Hickie JB, Balasubramaniam S.  On the effects of dietary n-3 fatty acids (Maxepa) on plasma lipids and lipoproteins in patients with hyperlipidaemia . Atherosclerosis. 1985;;54:75-88.
21 +
Sullivan DR, Sanders TAB, Trayner IM, Thompson GR.  Paradoxical elevation of LDL apoprotein B levels in hypertriglyceridemic patients and normal subjects ingesting fish oil . Atherosclerosis. 1986;;61:129-134.
22 +
Stout RW.  Insulin and atheroma: 20-year perspective . Diabetes Care. 1990;;13:631-654.
23 +
Kahn SE, Beard JC, Schwartz MW, et al.  Increased B-cell secretory capacity as mechanism for islet adaption to nicotinic acid—induced insulin resistance . Diabetes. 1989;;38:562-568.
24 +
Coronary Drug Project Research Group.  Clofibrate and niacin in coronary heart disease . JAMA. 1975;;231:360-381.
25 +
Weiss TE, Segaloff A, Moore C.  Gout and diabetes . Metabolism. 1957;;6:103-106.
26 +
Whitehouse FW, Cleary WJ Jr.  Diabetes mellitus in patients with gout . JAMA. 1966;;197:73-76.
27 +
Garg A, Grundy SM.  Lovastatin for lowering cholesterol levels in non—insulin-dependent diabetes mellitus . N Engl J Med. 1988;;318:81-86.
28 +
American Diabetes Association.  Role of cardiovascular risk factors in prevention and treatment of macrovascular disease in diabetes . Diabetes Care. 1989;;12:573-579.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Stern MP, Patterson JK, Haffner SM, Hazuda HP, Mitchell BD.  Lack of awareness and treatment of hyperlipidemia in type II diabetes in a community survey . JAMA. 1989;;262:360-364.
2 +
Barrett-Connor E, Orchard T.  Diabetes and heart disease . In: National Diabetes Data Group. Diabetes in America: Diabetes Data Compiled 1984 . Washington DC, US Dept of Health and Human Services; 1985;:chap 16. National Institutes of Health publication 85-1468.
3 +
National Cholesterol Education Program Expert Panel, National Heart Lung and Blood Institute.  Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med. 1988;;148:36-69.
4 +
National Diabetes Data Group.  Classification and diagnosis of diabetes mellitus and other categories of glucose tolerance . Diabetes. 1979;;28:1039-1057.
5 +
American Diabetes Association.  Nutritional recommendations and principles for individuals with diabetes mellitus: 1986 . Diabetes Care. 1987;;10:126-132.
6 +
Blankenhorn DM, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA. 1987;;257:3233-3240.
7 +
Manual of Laboratory Operations: Lipid Research Clinics Program: Lipid and Lipoprotein Analysis . 2nd ed. Washington, DC: US Dept of Health and Human Services; 1982;.
8 +
Roeschlau P, Bernt E, Gruber W.  Enzymatische Bestimmung gesamt-cholesterins im Serum . Z Klin Chem Klin Biochem. 1974;;12:226.
9 +
Wahlefeld AW.  Triglyceride determination after enzymatic hydrolysis . In: Bergmeyer HU, ed. Methods of Enzymatic Analysis . Orlando, Fla: Academic Press Inc; 1974;;4:1831-1835.
10 +
Zar JH. Biostatistical Analysis. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall International Inc; 1984;:222-225.
11 +
Winer BJ. Statistical Principles in Experimental Design. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1971;:261-308.
12 +
Altschul R, Hoffer A, Stephen JD.  Influence of nicotinic acid on serum cholesterol in man . Arch Biochem Biophys. 1955;;54:558-559.
13 +
Gurian H, Adlersberg D.  The effect of large doses of nicotinic acid on circulating lipids and carbohydrate tolerance . Am J Med Sci. 1959;;237:12-22.
14 +
Gaut ZN, Pocelinko R, Solomon HM, Thomas GB.  Oral glucose tolerance, plasma insulin, and uric acid excretion in man during chronic administration of nicotinic acid . Metabolism. 1971;;20:1031-1035.
15 +
Miettinen TA, Taskinen M-R, Pelkonen R, Nikkila EA.  Glucose tolerance and plasma insulin in man during acute and chronic administration of nicotinic acid . Acta Med Scand. 1969;;186:247-253.
16 +
Parsons WB Jr.  Studies of nicotinic acid use in hypercholesterolemia: changes in hepatic function, carbohydrate tolerance and uric acid metabolism . Arch Intern Med. 1961;;107:85-99.
17 +
Molnar GD, Berge KG, Rosevear JW, McGuckin WF, Achor WP.  The effect of nicotinic acid in diabetes mellitus . Metabolism. 1964;;13:181-189.
18 +
Vega GL, Grundy SM.  Gemfibrozil therapy in primary hypertriglyceridemia associated with coronary heart disease: effects on metabolism of low-density lipoproteins . JAMA. 1985;;253:2398-2403.
19 +
Garg A, Grundy SM.  Gemfibrozil alone and in combination with lovastatin for treatment of hypertriglyceridemia in NIDDM . Diabetes. 1989;;38:364-372.
20 +
Simons LA, Hickie JB, Balasubramaniam S.  On the effects of dietary n-3 fatty acids (Maxepa) on plasma lipids and lipoproteins in patients with hyperlipidaemia . Atherosclerosis. 1985;;54:75-88.
21 +
Sullivan DR, Sanders TAB, Trayner IM, Thompson GR.  Paradoxical elevation of LDL apoprotein B levels in hypertriglyceridemic patients and normal subjects ingesting fish oil . Atherosclerosis. 1986;;61:129-134.
22 +
Stout RW.  Insulin and atheroma: 20-year perspective . Diabetes Care. 1990;;13:631-654.
23 +
Kahn SE, Beard JC, Schwartz MW, et al.  Increased B-cell secretory capacity as mechanism for islet adaption to nicotinic acid—induced insulin resistance . Diabetes. 1989;;38:562-568.
24 +
Coronary Drug Project Research Group.  Clofibrate and niacin in coronary heart disease . JAMA. 1975;;231:360-381.
25 +
Weiss TE, Segaloff A, Moore C.  Gout and diabetes . Metabolism. 1957;;6:103-106.
26 +
Whitehouse FW, Cleary WJ Jr.  Diabetes mellitus in patients with gout . JAMA. 1966;;197:73-76.
27 +
Garg A, Grundy SM.  Lovastatin for lowering cholesterol levels in non—insulin-dependent diabetes mellitus . N Engl J Med. 1988;;318:81-86.
28 +
American Diabetes Association.  Role of cardiovascular risk factors in prevention and treatment of macrovascular disease in diabetes . Diabetes Care. 1989;;12:573-579.

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