Issue 158 Item 11 Nicotinamide Preserves Baseline C-Peptide Secretion in Childre

Nicotinamide (NA), alone or with vitamin E, appears to preserve baseline C-peptide secretion for up to 2 years in newly diagnosed pre-pubertal children with type 1 diabetes who take intensive insulin therapy. NA reduces toxicity from free oxygen radicals, and various reports suggest that it may increase the clinical remission rate, improve metabolic control and modify beta cell function in type 1 diabetics. Likewise, vitamin E inhibits lipid peroxidation, which may protect islet beta cells from the effects of cytokines.

Antonio Crino, MD, with the Ospedale Bambino Gesu, in Rome, Italy, and colleagues on behalf of the IMDIAB Group investigated whether the addition of vitamin E to NA could improve metabolic control and residual beta cell function as measured by C-peptide secretion in children and adolescents with recent onset type 1 diabetes.

Sixty-four patients, mean age 8.8 years, were included in the study. Thirty-two patients were randomized to NA at a dose of 25 mg/kg body weight plus vitamin E at a dose of 15 mg/kg body weight. The remaining 32 patients received NA only. All patients received intensive insulin therapy.

Three patients withdrew from the study over the 2-year follow up. Patients diagnosed when they were younger than 9 years of age showed significantly reduced C peptide levels compared with those older than 9 years at diagnosis and at 2 years follow-up.

However, at 6 months, patients younger than 9 years of age treated with NA plus vitamin E had significantly higher C-peptide levels compared with the NA group (P < .003). Furthermore, C peptide levels observed at diagnosis were maintained two years later. According to the researchers, no adverse effects were reported in patients of either group over the follow-up period. “Most importantly, episodes of severe hypoglycemia were limited and were not significantly different between the two treated groups,” they write. “It is now well recognized that residual C-peptide secretion is associated with a reduced prevalence of late diabetic complications, therefore our aim with young patients with type 1 diabetes is to prolong, as far as possible, such secretion,” Dr. Crino and colleagues conclude. “It appears that this is now feasible, even in very young children, for at least 2 years after diagnosis using intensive insulin therapy,” they note. J Endocrinol 150: 719-724 ================================ DID YOU KNOW: Exercise regimens may be associated with more benefits for patients with type 2 diabetes than previously believed. A new study found that in addition to improved body mass index, (BMI), fitness levels and dyslipidemia, a supervised 6 month exercise regimen improved underlying metabolic mechanisms, which led to adverse lipid levels in patients with Type 2 diabetes. Patients showed significant improvements in VLDL, body fat and all lipids. J Clin Endocrinol Metab.2004;2:688-694