Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus

Article Abstract:

Abnormal blood lipid levels (dyslipidemia) are common among patients with non-insulin-dependent diabetic mellitus (NIDDM). This is a serious problem and probably a major contributor to coronary heart disease, which seriously affects many of these patients. The National Cholesterol Education Program recently recommended nicotinic acid, a B vitamin also known as niacin, for the treatment of high blood cholesterol and triglyceride levels. To evaluate whether these recommendations could be used safely for patients with NIDDM, given their other metabolic abnormalities, 13 male NIDDM patients, aged 49 to 68 years, who attended a lipid and diabetes clinic at the Veterans Administration Hospital in Dallas, Texas were studied. Six of these patients had coronary heart disease with no recent complications. Patients received nicotinic acid or no therapy for eight weeks, and then switched to the opposite treatment for the next eight weeks. The nicotinic acid dose was gradually increased from 50 milligrams three times a day to 1.5 grams three times a day by the end of the third week. During nicotinic acid therapy, total blood cholesterol was reduced by 24 percent, triglycerides by 45 percent, very low density lipoprotein (VLDL) by 58 percent, and low density lipoprotein (LDL) by 15 percent. The high density lipoprotein (HDL), which is considered to be the favorable fraction, rose consistently with an average increase of 34 percent, and the total cholesterol/HDL ratio also improved markedly. Glycemic control (blood glucose management) deteriorated during nicotinic acid therapy, as glucose levels rose an average of 16 percent. Uric acid levels also rose in all patients during therapy. Most of the patients had few or minor side effects from the nicotinic acid. Nicotinic acid improved the lipoprotein profile of these patients, but it may worsen hyperglycemia in patients with NIDDM. The mechanism for this response is not known, but it is theorized that nicotinic acid may induce insulin resistance. Although hyperglycemia may be managed with hypoglycemic drugs, this may lead to other problems. The increase in uric acid is also dangerous for NIDDM patients because of their susceptibility to hyperuricemia, gout and kidney disease. Although the study population tolerated the nicotinic therapy well, it is recommended that this therapy be used with caution in patients with NIDDM. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Physiological aspects, Drug therapy, Hyperlipidemia, Niacin

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Dietary treatment of diabetes mellitus

Article Abstract:

Doctors need to tell their patients with type 2 diabetes about dietary changes they can make to manage their disease. A study published in 2000 showed that a high-fiber diet can lower blood sugar, insulin, and cholesterol levels. The benefit was similar to the benefit from some drugs. The diet was especially high in soluble fiber, such as the kind found in fruits. Eating foods with a low glycemic index can also be helpful. The glycemic index measures how high blood sugar rises after eating a specific food.

Editorial

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Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus

Article Abstract:

Large amounts of soluble fiber in the diet may be beneficial for people with type 2 diabetes. This was the conclusion of a study of 13 patients with type 2 diabetes who followed two diets, each one for six weeks. One diet contained moderate amounts of fiber and the other contained greater amounts of fiber, especially soluble fiber. All 13 patients had lower blood levels of glucose, insulin and cholesterol while on the high-fiber diet.

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