Nicotinic Acid and Niacin

Traditionally, diabetes has been regarded as a relative contraindication to the use of niacin secondary to its worsening effect on glucose homeostasis. There are case reports of severe hyperglycemia resulting from use of niacin (41). Most recent studies have shown that hyperglycemic effect of niacin is dose-dependent (42). Severe hyperglycemia with niacin use is seen mostly in patients with established glucose intolerance or with a diagnosis of diabetes (43). The higher use of niacin in non-insulin-dependent diabetic patients has resulted in 16% increase in plasma glucose levels and a 21% increase in glycosylated hemoglobin levels (44).

Mechanism of niacin-induced hyperglycemia appears to be an increased hepatic glucose output due to enhanced gluconeogensis, secondary to rebound increase in the flow of free fatty acids (FFA) to the liver (45).

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