It's been a confusing few years for people with diabetes, with concerns about the risks tied to various diabetes medications have weighing heavily on the minds of patients and clinicians. This week, even as federal regulators look into the safety of Avandia—the latest diabetes medication in the news because of its possible cardiovascular risks—a new study suggests that an old drug called salsalate, typically prescribed for arthritis, could hold promise for people with type 2 diabetes.
It's too early to be sure, experts say. Salsalate, an anti-inflammatory medication, was first looked at as a potential treatment for diabetes during the 1800s, but it never caught on, "probably because people didn't know the difference between type 1 and type 2 diabetes," says study coauthor Steven Shoelson, professor of medicine at Harvard Medical School and associate research director at Joslin Diabetes Center. The drug, he says, would serve no use for type 1 diabetes, which requires insulin treatment. But given the "modern-day thinking about inflammation being a mediator in [type 2] diabetes," he says, this "sounded like a good connection."
In the new research, published in the Annals of Internal Medicine, a greater proportion of people treated with salsalate saw their A1C levels (a measure of blood sugar over time) decrease than did those in the placebo group. About 44 percent of those taking 3 grams per day of salsalate, 54 percent of those taking 3½ grams per day, and 60 percent of those taking 4 grams per day saw their A1C levels decrease by more than 0.5 percent, compared with 15 percent of those in the placebo group. The study, which included 108 people ages 18 to 75, was small, and its results are considered preliminary—but intriguing nonetheless.
"It may turn out that this is an inexpensive and somewhat effective treatment for diabetes, but there are a lot of if's that have to be answered along the way," says Robert Vigersky, president of the Endocrine Society and director of the Diabetes Institute at Walter Reed Army Medical Center, who was not involved in the new study.
Could the drug one day replace mainstays Avandia or Actos? Possibly, Shoelson says. More likely, he says, the drug may eventually be used as an add-on therapy to Metformin, another diabetes medication. "We haven't tested it as a primary drug yet," he says. Vigersky says he thinks it's unlikely that salsalate is potent enough to work as a stand-alone treatment. "It clearly is not as potent as Avandia and Actos," he says, "but it does add another drug that we can use in various combinations" for treatment.
[Here are 6 things you should know about Avandia.]
The study raised a few concerns that will be examined in future research. Some people who took salsalate experienced mild hypoglycemia, and some saw increased amounts of protein in their urine. And given the concern about the cardiovascular safety of other diabetes medications, salsalate will have to undergo thorough review to ensure it doesn't increase heart risk. "We think we're in good shape there because we actually think it is cardioprotective," based on early findings, Shoelson says.
Assuming the drug passes all research and regulatory hurdles, it could be five to 10 years from approval as a treatment for diabetes. Meantime, Shoelson highly recommends weight loss, healthy diet, and exercise. "With that, you can eliminate many of the medications or at least reduce the dosage," he says. "We don't want to lose sight of the fact that better lifestyle can solve a lot of problems."