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Elevation of fasting morning glucose relative to hemoglobin A1c in normoglycemic patients treated with niacin and with statins.
J Clin Lipidol 2012 Mar-Apr; 6(2):168-73JC

Abstract

BACKGROUND

Niacin increases fasting glucose levels, and statins modestly increase the rate of new-onset diabetes. The clinical importance and mechanisms of these effects are not fully explored.

OBJECTIVE

On the basis of anecdotal observations, we hypothesized that elevated morning fasting glucose may be accompanied by relatively normal hemoglobin A1c (HbA1c) in patients treated with niacin and other lipid-modifying drugs. We conducted a retrospective cohort analysis to test this hypothesis.

METHODS

The Duke Lipid Clinic database (1994-2007) was screened for simultaneous determinations of fasting morning glucose and HbA1c, yielding 1483 data pairs among 554 subjects. Subjects with diabetes, by clinical diagnosis, medication, or any HbA1c ≥6.5%, or nondiabetes were analyzed separately. Repeated-measures linear regression featured glucose as dependent variable and included terms for HbA1c, drug(s), and their interaction.

RESULTS

Regression lines for glucose on HbA1c had altered slopes in the presence of niacin and/or statin use in normoglycemic subjects. The corresponding interaction terms (drug and HbA1c) were significant (niacin P = .026, statin P = .013). Fibrate use had no effect (interaction P = .49). When modeled together, niacin and statin effects were independent. Regression curves in diabetic patients were not affected by lipid medications.

CONCLUSION

Elevated fasting glucose may be accompanied by relatively normal HbA1c in niacin- and statin-treated patients. HbA1c reflects average daily glucose levels and is likely a better measure of the glycemic effect of lipid medications. Because our data were retrospective, confirmation from randomized trials is needed.

Authors+Show Affiliations

Beaumont Hospital, Royal Oak, MI, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22385550

Citation

Rajanna, Veena, et al. "Elevation of Fasting Morning Glucose Relative to Hemoglobin A1c in Normoglycemic Patients Treated With Niacin and With Statins." Journal of Clinical Lipidology, vol. 6, no. 2, 2012, pp. 168-73.
Rajanna V, Campbell KB, Leimberger J, et al. Elevation of fasting morning glucose relative to hemoglobin A1c in normoglycemic patients treated with niacin and with statins. J Clin Lipidol. 2012;6(2):168-73.
Rajanna, V., Campbell, K. B., Leimberger, J., Mohanty, B. D., & Guyton, J. R. (2012). Elevation of fasting morning glucose relative to hemoglobin A1c in normoglycemic patients treated with niacin and with statins. Journal of Clinical Lipidology, 6(2), pp. 168-73. doi:10.1016/j.jacl.2011.12.008.
Rajanna V, et al. Elevation of Fasting Morning Glucose Relative to Hemoglobin A1c in Normoglycemic Patients Treated With Niacin and With Statins. J Clin Lipidol. 2012;6(2):168-73. PubMed PMID: 22385550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevation of fasting morning glucose relative to hemoglobin A1c in normoglycemic patients treated with niacin and with statins. AU - Rajanna,Veena, AU - Campbell,Kristen B, AU - Leimberger,Jeffrey, AU - Mohanty,Bibhu D, AU - Guyton,John R, Y1 - 2011/12/23/ PY - 2011/09/13/received PY - 2011/12/18/revised PY - 2011/12/20/accepted PY - 2012/3/6/entrez PY - 2012/3/6/pubmed PY - 2012/7/14/medline SP - 168 EP - 73 JF - Journal of clinical lipidology JO - J Clin Lipidol VL - 6 IS - 2 N2 - BACKGROUND: Niacin increases fasting glucose levels, and statins modestly increase the rate of new-onset diabetes. The clinical importance and mechanisms of these effects are not fully explored. OBJECTIVE: On the basis of anecdotal observations, we hypothesized that elevated morning fasting glucose may be accompanied by relatively normal hemoglobin A1c (HbA1c) in patients treated with niacin and other lipid-modifying drugs. We conducted a retrospective cohort analysis to test this hypothesis. METHODS: The Duke Lipid Clinic database (1994-2007) was screened for simultaneous determinations of fasting morning glucose and HbA1c, yielding 1483 data pairs among 554 subjects. Subjects with diabetes, by clinical diagnosis, medication, or any HbA1c ≥6.5%, or nondiabetes were analyzed separately. Repeated-measures linear regression featured glucose as dependent variable and included terms for HbA1c, drug(s), and their interaction. RESULTS: Regression lines for glucose on HbA1c had altered slopes in the presence of niacin and/or statin use in normoglycemic subjects. The corresponding interaction terms (drug and HbA1c) were significant (niacin P = .026, statin P = .013). Fibrate use had no effect (interaction P = .49). When modeled together, niacin and statin effects were independent. Regression curves in diabetic patients were not affected by lipid medications. CONCLUSION: Elevated fasting glucose may be accompanied by relatively normal HbA1c in niacin- and statin-treated patients. HbA1c reflects average daily glucose levels and is likely a better measure of the glycemic effect of lipid medications. Because our data were retrospective, confirmation from randomized trials is needed. SN - 1933-2874 UR - https://www.unboundmedicine.com/medline/citation/22385550/Elevation_of_fasting_morning_glucose_relative_to_hemoglobin_A1c_in_normoglycemic_patients_treated_with_niacin_and_with_statins_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1933-2874(11)00837-3 DB - PRIME DP - Unbound Medicine ER -