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Does Niacin Cause Diabetes?

Studies focus on whether niacin therapy and new-onset diabetes link is coincidence or something more.

Over the years, there has been conflicting data on the risk vs. benefit assessment of the use of niacin. The Coronary Drug Project, which took place before statins came to market, found a 17% decrease in non-fatal myocardial infarction (MI) in patients using niacin. Studies such as this seem to show a benefit with regard to lowering total cholesterol and increasing high density lipoprotein (HDL). However, more recent studies, including AIM-HIGH and HPS2-THRIVE, have shown no cardiovascular benefit by adding niacin to statin therapy. In addition, it has been shown that niacin increases blood glucose levels. Therefore it has been inferred that it may contribute to new-onset diabetes. However, there has not previously been a study conducted to look at new-onset diabetes in patients using niacin. Definitive evidence showing whether or not niacin increases risk of new-onset diabetes could be an important tool in deciding if and when to initiate therapy.

This study was a meta-analysis of 11 randomized trials conducted to confirm whether or not a link exists between niacin therapy and new-onset diabetes. The trials were found by conducting a search of the Cochrane database and EMBASE between the years 1975-2014. Inclusion criteria consisted of randomized controlled trials on niacin and its cardiovascular effects with >50 non-diabetic participants. This was conducted as a 2-armed study with a total of 26,340 participants. 13,121 were assigned to the niacin therapy group and 13,219 were assigned to the control group. New-onset diabetes was defined as a report of diabetes or a fasting plasma glucose of >7 mmol/L at a 3.6 year follow-up and was evaluated using risk ratios (RR) with 95% confidence intervals. The I2 statistic was used to assess the heterogeneity between trials.

Of the 26,340 total participants analyzed, 725 in the niacin group and 646 in the control group developed new-onset diabetes. The use of niacin was found to be associated with a RR of 1.34 (CI: 1.21-1.49). This represents a 34% increase in risk of developing diabetes compared to placebo. There was very little heterogeneity between trials (I2=0.0%; P=0.87).

In light of this meta-analysis, there is evidence to suggest that therapy with niacin could increase an individual’s risk of developing diabetes. This should be taken into consideration when weighing the pros and cons of beginning therapy with niacin.

Practice Pearls:

  • The results of this study suggest that niacin therapy increases the risk of developing diabetes.
  • The cardiovascular benefit of niacin therapy may outweigh the risk of developing diabetes.
  • When weighing the pros and cons of beginning therapy with niacin; the risk of developing diabetes should be part of the discussion.

Researched and prepared by Devon Brooks, Doctor of Pharmacy Candidate from LECOM College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE

Goldie, Christina, Taylor, Allen J., Nguyen, Peter, et al. “Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomized controlled trials.” Heart. 1.6 (2015): 1-7. Heart. Web. 3 Feb. 2016.