Nicotinamide vs Steroids in Recent-Onset Diabetes: Impact on 3-Cell Function

What is it about?

The study aimed to compare the effect of nicotinamide (NCT) alone or in combination with deflazacort (DFL) on the integrated parameters of metabolic control in patients with recent-onset insulin-dependent diabetes mellitus (IDDM). The study found that the addition of DFL to NCT for 3 months may improve only stimulated beta-cell function detectable 1 year after clinical onset compared with patients treated with NCT alone. The increase in C-peptide at 3 months reflects purely DFL-induced insulin resistance. DFL has been shown not to substantially increase blood glucose levels in prediabetic subjects as other steroids may do. The combination of DFL with NCT in the early phases of IDDM may favor the action of NCT on beta-cell protection. However, the slight effect of DFL in increasing only stimulated beta-cell function compared with patients receiving NCT alone appears similar in children and adults. The study suggests that a low incidence of microvascular complications has been reported in IDDM patients with some residual beta-cell function, including protection from proliferative retinopathy in those who still maintain beta-cell function. This encourages adoption of some sort of adjunct therapy to insulin at diagnosis of IDDM.

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Why is it important?

The research is important because it investigates the use of nicotinamide (NCT) in combination with an anti-inflammatory steroid, deflazacort (DFL), to improve metabolic control and potentially favor clinical remission in patients with recent-onset insulin-dependent diabetes mellitus (IDDM). IDDM is caused by an autoimmune process that destroys β-cells, and this research aims to explore whether steroids, alone or in combination with other drugs, can improve residual β-cell function in recent-onset IDDM patients. Key Takeaways: 1. The addition of DFL to NCT for 3 months may improve only stimulated β-cell function detectable 1 year after clinical onset compared with patients treated with NCT alone. 2. The increase in C-peptide at 3 months reflects purely DFL-induced insulin resistance. 3. The long-term effect of DFL at 1 year may reflect its anti-inflammatory property efficacious at the time of diagnosis when the cytotoxic β-cell process is still active. 4. DFL has been shown not to substantially increase blood glucose levels in prediabetic subjects, which is an advantage in diabetic patients. 5. Recent data suggest that DFL possesses interesting properties in protecting animals from developing diabetes by inhibiting macrophage-derived interleukin-1 secretion and blocking the production of many other cytokines that directly or indirectly are important mediators of β-cell damage. 6. The combination of an anti-inflammatory agent with NCT may be considered at the time of the first presentation of diabetic symptoms.