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While it is often assumed that simplifying dosing frequency can improve adherence in general, the step from weekly to monthly has not been consistently demonstrated to deliver additional adherence gains across settings

Brown fat mitochondria express UCP1, which creates an alternative pathway for protons

Individuals with diabetes or those taking glucose-lowering medications should use caution, as some forms of vitamin B3 can affect insulin sensitivity and glucose metabolism

Exogenous causes include abuse of insulin secretagogues such as sulfonylureas or meglitinides and abuse of insulin, which may occur in patients with Munchausen syndrome, Munchausen syndrome by proxy, or malingering