Arthritis Painkiller May Curb Diabetes

Diabetes patients may improve glucose control with salsalate treatment

(RxWiki News) An aspirin-like painkiller that is commonly used to treat the inflammation of arthritis may prove to be an effective medication for diabetes as well.

Salsalate (brand names Disalcid, Amigesic, Salflex) is a type of nonsteroidal anti-inflammatory drug (NSAID).

In previous research on this medication, scientists found that inflammation was a factor in the development of type 2 diabetes and that salsalate may lower blood sugar levels.

A recent larger study supports those findings.

"Maintain a healthy weight to reduce diabetes complications."

Allison Goldfine, MD, head of the Section of Clinical Behavioral & Outcomes Research at Joslin Diabetes Center and associate professor of medicine at Harvard Medical School in Boston, and her colleagues evaluated 286 patients with type 2 diabetes.

These patients were all experiencing inadequate blood glucose (sugar) control with their current medication. For 48 weeks, they received either regular treatment with salsalate or placebo (fake medication).

Salsalate is in a class of NSAIDs called salicylates. These NSAIDs are found in many plants, such as the willow. Early physicians such as Hippocrates, Galen and medieval herbalists relied on salicylate-containing botanicals for their medicinal properties.

At the end of this trial, the investigators measured hemoglobin A1c, or HbA1c — a measurement of average blood sugar control over the previous six to twelve weeks. In the salsalate group, HbA1c levels were 37 percent lower compared to the placebo group.

The study authors noted that patients in the salsalate group required fewer additional diabetes medications to control their blood sugar than patients in the placebo group.

"Salsalate may have an important role in diabetes treatment and may also help us learn more about how inflammation contributes to the development of type 2 diabetes," said Dr. Goldfine in a press release.

In a separate study from 2010, researchers evaluated varying doses of salsalate in 108 participants with type 2 diabetes for 14 weeks. Patients taking the highest doses experienced reduced HbA1c of 0.5 percent or more.

The 2010 study was Stage 1 of TINSAL-T2D (Targeting Inflammation Using Salsalate in Type 2 Diabetes) and the current findings are Stage 2.

In this study, salsalate’s anti-inflammatory effects were shown by reductions in neutrophils and lymphocytes (white blood cells), which are elevated in obesity and metabolic syndrome, but all remained within normal range.

Uric acid, which is associated with cardiometabolic conditions and progression of renal (kidney) disease, decreased by 18 percent in the salsalate group.

The salsalate group also showed improvements in markers associated with coronary risk: a 9 percent reduction in triglycerides and a 27 percent increase in adiponectin, a potentially cardioprotective protein from adipocytes.

According to Dr. Goldfine, "The reductions in these cardiovascular risk factors paralleled improved glycemia [the level of blood glucose]."

MedlinePlus warns, however, that people who take NSAIDs (other than aspirin) such as salsalate may have a higher risk of having a heart attack or stroke than people who do not take these medications.

The salsalate group also had modest increases in LDL ("bad") cholesterol and urine albumin (sign of kidney damage). In addition, these patients gained a little weight.

Salsalate does not yet have approval by the US Food and Drug Administration (FDA) as a diabetes medication. To determine its safety, the next step for Dr. Goldfine and her colleagues is to study the effect of the medication on the heart. She is currently leading research to evaluate how it affects coronary artery plaque volume in participants with established heart disease. The results should be available in two years.

"The study will help us better understand the risk/benefit ratio of using salsalate to treat diabetes," said Dr. Goldfine.

This study was published in July in the Annals of Internal Medicine. The research was sponsored by the National Institutes of Health.

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Review Date: 
July 5, 2013