Niacin Safe for People with Diabetes

Marshall B. Elam, MD, and a multi-center team at the University of Tennessee, Memphis, are saying patients with type 2 diabetes who receive lipid-modifying doses of niacin show a significant increase in high-density lipoprotein (HDL or “good”) cholesterol and a significant decrease in triglycerides and low-density lipoprotein (LDL or “bad”) cholesterol levels.

Their results were derived from the Arterial Disease Multiple Intervention Trial, which studied 468 patients with peripheral arterial disease. Of the 468 patients in this trial, 125 had diabetes. The team randomized all patients to receive either niacin at 3000 mg per day, or a placebo. According to the September 13 issue of Journal of the American Medical Association, 64 diabetic patients received niacin, as did 173 nondiabetics.

The researchers note that niacin use significantly increased HDL cholesterol by 29 percent, both in people with diabetes and in those without. In addition, niacin decreased triglycerides in people with and without diabetes by 23 and 28 percent and LDL cholesterol by eight and nine percent, respectively. Subjects with and without diabetes receiving the placebo increased HDL cholesterol by zero and two percent, respectively, and increased triglycerides seven and zero percent. One and one percent, respectively, demonstrated increased levels in LDL cholesterol.

The researchers note glucose levels increased by 8.7 mg/dl in people with diabetes receiving niacin and by 6.3 mg/dl in the nondiabetics receiving niacin.

“Despite current recommendations against use of niacin in diabetes, the present study demonstrates that lipid-modifying doses of immediate-release niacin can be used safely in patients with stable, controlled, type 2 diabetes,” wrote Elam and colleagues. “Niacin therapy may be considered as an alternative to statin drugs or fibrates in patients with diabetes in whom these agents are not tolerated, or in whom they fail to sufficiently correct hypertriglyceridemia or low HDL cholesterol.”

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