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| |  ESPE: Could Nicotinamide And Vitamin E Have Synergistic Effect And Reduce Insulin Usage? By Cameron Johnston Special to DG News MONTREAL, QC -- July 11, 2001 -- The combination of nicotinamide and vitamin E might have a synergistic effect in lowering daily insulin usage among newly diagnosed Type 1 diabetics. Nicotinamide is an important B-complex vitamin that is used as an intermediate agent in many pharmaceuticals. In previous studies, it has been shown to have some effect in preserving beta-cell function. Vitamin E might work at the B-cell level by reducing cytotoxicity mediated by cytokines, but it has never been shown to affect the autoimmune process that leads to the loss of B-cell function, nor does it have an impact on the insulin process. Italian investigators presented the results of a new study involving children (mean age 7.8 years) who had been diagnosed with Type 1 diabetes within the previous four weeks yesterday (July 10) at the the 6th joint meeting of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology (ESPE) in collaboration with the Australasian Paediatric Endocrine Group, the Japanese Society for Pediatric Endocrinology, and the Latin American Society for Paediatric Endocrinology, held in Montreal, Quebec, Canada. Twenty-seven subjects received nicotinamide alone (25 mg/kg/day), and 29 received combination therapy consisting of nicotinamide plus vitamin E (25 mg/kg/day and 15 mg/kg/day, respectively). All subjects received an insulin regimen consisting of three doses of rapid-acting insulin at meal time and one injection of intermediate insulin at bed time for a period of 12 months. Children under the age of 15 who develop Type 1 diabetes generally experience a faster loss of B-cell function, and a more severe form of the disease, which leaves them more susceptible than others to micro- and macrovascular damage as they get older. In this study, baseline insulin usage was 0.8 IU/kg/day in the combination therapy group and 0.89 IU/kg/day in the nicotinamide alone group. In both groups insulin dosing fell sharply during the first three months of therapy, to as low as 0.5 IU/kg/day in the combination therapy group, then increased gradually. At the end of the trial, it was still lower than at baseline -- 0.6 IU/kg in the combination therapy group and 0.7 in the nicotinamide alone group (p=0.01). Plasma C peptides were significantly higher in the combination therapy group. There was no significant difference in glycosylated hemoglobins between the two groups, with HbA1c in both groups falling from 10-11 percent to 7 percent. "This is the first trial to demonstrate that in very young children with Type 1 diabetes, nicotinamide used in combination with vitamin E can optimize hemoglobin and lower insulin use to as low as 05 units/kg/day," said lead investigator Dr. Antonino Crino, an employee of Novo Nordisk Italia, and investigator on the IMDIAB Study group, based in Rome. The researchers stopped well short of suggesting that either nicotinamide or vitamin E would slow the loss of beta-cell function, but they did say the data was “encouraging” and seemed to suggest a synergistic action between the two vitamins.
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