Endocrine Abstracts

Patients with type 2 diabetes have an increased risk of premature coronary heart disease (CHD). One of the underlying reasons for this increased risk is atherogenic dyslipidemia. Current management strategies focus on the initial use of statin or fibrate therapy (the latter approach indicated in patients with pronounced hypertriglyceridemia).

American Diabetes Association recognizes serum triglycerides as a surrogate for atherogenic triglyceride-rich lipoproteins and suggests a target of <150 mg/dl. This target goal of TG is often very difficult to achieve in spite of fenofibrate treatment. So we tried to evaluate the effect of combination with acipimox, which is an analog of nicotinic acid. Acipimox is also believed to improve glucose control by enhancing insulin sensitivity unlike the case of nicotinic acid. We selected seventeen patients with type 2 diabetes whose glycemic control was stable for 6 months, but elevated serum TG level >150 mg/dl with fenofibrate monotherapy. In this study acipimox 250 mg capsule was administered twice daily for 2 months, and we measured lipid profile and glycated hemoglobin, creatine kinase and myoglobin concentration before and after the addition of acipimox.

Results: 1. One female patient was withdrawn because of myalgia in both thigh muscle after 3 days of acipimox combination treatment, but her serum CK and MB concentration were normal.

2. Sixteen patients were completed, and serum TG level was decreased significantly from 328.3±35.29 to 192.4±30.59 mg/dl, and total cholesterol decreased significantly also. But other lipid parameters were not changed significantly.

3. There were no side-effects such as myositis, rhabdomyolysis and liver dysfunction.

Conclusion: This preliminary study showed clearly that in patients with type 2 diabetes who have elevated TG level inspite of fenofibrate monotherapy we can decrease serum TG level significantly with the addition of acipimox.