Joslin Diabetes Center - Harvard Medical School, USA
Posters & Accepted Abstracts: J Diabetes Metab
Evidences indicate that salsalate treatment improves glucose homeostasis. The aim of this study is to evaluate the effect of salsalate on glycemia. We searched PubMed for randomized trials looking at the effect of salsalate on glycemia in adults. A MEDLINE search from 01-2015 to 11-2016 was undertaken using: Salsalate (diabetes, glucose). Only randomized, placebo-controlled studies evaluating salsalate versus placebo were included. Meta-analyses were performed for differences in fasting plasma glucose (FPG) (mmol/l) and hemoglobin A1c (%) between baseline and end-of-study. The outcome was calculated as standardized mean difference (SMD) with 95% confidence interval (CI). The quality of the studies was determined by the Jadad score. The random effects model was used to calculate the combined outcome. Heterogeneity was assessed by I2 statistic. Publication bias was assessed by the trim-and-fill analysis. Literature search, data gathering and quality assessment were performed independently by 2 investigators. All graphs and calculations were obtained using Comprehensive Meta-Analysis version 2 (Biostat, Englewood, NJ). We included 9 studies (N=933) reporting on fasting FPG or A1c. Salsalate dose ranged from 3 to 4.5 g per day. Study duration ranged from 4 to 120 weeks. Out of 9 studies, 8 were double blinded and 1 was single blinded. Jadad score ranged from 3-5. Salsalate therapy was associated with a greater decrease in the SMD for FPG than placebo with SMD -0.58 (95% CI -0.76 to -0.41; p<0.001). Heterogeneity was moderate with I2=30% (p=0.16). Sensitivity analyses by removing one study at a time showed no bias but there was publication bias. By adjusting for the four imputed studies, the difference remains significant SMD: -0.47 (95% CI -0.67 to -0.27). Salsalate was also associated with a greater reduction on the SMD for hemoglobin A1c than placebo with SMD -0.47 (95% CI -0.66 to -0.27; p<0.001). Heterogeneity was low with I2=20% and p=0.27. Sensitivity analysis showed no bias and there was no publication bias also. Salsalate has been marketed for pain relief since long time. One must consider these glycemic benefits in relation to potential risks. Larger randomized controlled trials are needed where the population might benefit the most.
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