Salsalate lowered HbA1c, inflammatory markers but increased LDL, urinary albumin in type 2 diabetics

Salsalate improved glycemic control and showed anti-inflammatory effects compared to placebo in adult patients with type 2 diabetes, a recent study found.

The randomized trial included 286 patients ages 18 to 75 with hemoglobin A1c (HbA1c) levels of 7.0% to 9.5%, recruited from three private practices and 18 academic centers in the U.S. For 48 weeks, patients added either 3.5 g of salsalate per day or placebo to their current diabetes regimens. Results were published in the July 2 Annals of Internal Medicine.

The mean HbA1c was 0.37% lower in the salsalate group than in the placebo group over the course of the study (95% CI, −0.53% to −0.21%; P<0.001). This reduction in HbA1c was achieved despite overall reductions in other diabetes medications in the salsalate group and medication increases in the placebo group. The salsalate also showed anti-inflammatory effects: lower circulating leukocyte, neutrophil and lymphocyte counts in patients taking it compared to those on placebo. Salsalate patients also had greater increases in adiponectin and hematocrit levels and decreases in fasting glucose, uric acid and triglycerides.

However, they also had increases in weight, low-density lipoprotein (LDL) cholesterol and urinary albumin levels. The clinical relevance of the albumin increase is unclear, the study authors said, since the increase reversed after discontinuation of the medication and patients' estimated glomerular filtration rates were unchanged. Continued, longer-term evaluation of the effects of salsalate on renal function and LDL cholesterol is warranted before it can be widely recommended for type 2 diabetes patients, the authors said.

The study was limited by its small size and short duration, but salsalate was well tolerated and showed glucose-lowering effects similar to other typical second-line oral diabetes therapies, the study authors concluded.