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Low doses of ER niacin (1000 or 1500 mg/d) are a treatment option for dyslipidemia in patients with type 2 diabetes.

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Background Although maintaining near normal glycemia delays onset and slows progression of diabetes complications, many diabetes patients and their physicians struggle to achieve glycemic targets. Best methods to support patients as they follow diabetes prescriptions and recommendations are unclear. Methods To test the efficacy of a behavioral diabetes intervention in improving glycemia in long-duration, poorly-controlled diabetes, we randomized 222 adults with diabetes (49% type 1, 53±12 years old, 18±12 years duration, hemoglobin A1c=9.0±1.1%) to attend 1) a 5-session manual-based, educator-led structured group intervention with cognitive behavioral strategies (structured behavioral arm), 2) educator-led attention-control group education program (group attention control), or 3) unlimited individual nurse and dietitian education sessions for 6 months (individual control). Outcomes were baseline, and 3, 6, and 12-month post-intervention hemoglobin A1c levels (primary), frequency of diabetes self-care, 3-day pedometer readings, 24-hour diet recalls, average number of glucose checks, physical fitness, depression, coping style, self-efficacy, and quality of life (secondary). Results Linear mixed modeling found that all groups improved hemoglobin A1c (p<0.001). However, the structured behavioral arm improved more than group and individual control arms (3-month HbA1c change: −0.8% versus −0.4% and −0.4%; groupXtime interaction p-value=0.04). Further, type 2 participants improved more than type 1 participants (type of diabetesXtime interaction p-value=0.04). Quality of life, glucose monitoring, and frequency of diabetes self-care did not differ by intervention over time. Conclusions A structured, cognitive behavioral program is more effective than two control interventions in improving glycemia in adults with long-duration diabetes. Educators can successfully utilize modified psychological and behavioral strategies. (ClinicalTrail.gov registration number: NCT000142922)

Despite the important role of high-intensity statins in reducing atherosclerotic cardiovascular disease events in secondary and primary prevention, substantial residual risk persists, particularly among high-risk patients with type 2 diabetes mellitus, metabolic syndrome, and obesity. Considerable attention is currently directed to the role that elevated triglycerides (TGs) and non-high-density lipoprotein cholesterol levels play as important mediators of residual atherosclerotic cardiovascular disease risk, which is further strongly supported by genetic linkage studies. Previous trials with fibrates, niacin, and most cholesterol ester transfer protein inhibitors that targeted high-density lipoprotein cholesterol raising, and/or TG lowering, have failed to show conclusive evidence of incremental event reduction after low-density lipoprotein cholesterol levels were "optimally controlled" with statins. Although omega-3 fatty acids are efficacious in lowering TG levels and may have pleiotropic effects such as reducing plaque instability and proinflammatory mediators of atherogenesis, clinical outcomes data are currently lacking. Several ongoing randomized controlled trials of TG-lowering strategies with an optimal dosage of omega-3 fatty acids are nearing completion.