Background: Diabetes is a well-known growing epidemic, but prediabetes is increasing at an even greater rate. Lifestyle changes are effective tools to prevent the progression of prediabetes to diabetes, yet many people are unable to follow such changes. Salsalate has been suggested as a possible treatment for diabetes as early as 1876 and as recently as in a 2013 study.

Objective: To review the recently published evidence about the potential therapeutic benefits of the old drug salsalate for individuals who meet the criteria of having prediabetes.

Discussion: With the rising incidence of obesity and prediabetes, it has become prudent to look for more therapeutic options. Salsalate belongs to the salicylate drug class, which has been shown to inhibit I-κB kinase, thereby inhibiting the nuclear factor-κB (NF-κB) cascade and decreasing the production of inflammatory cytokines, as well as decreasing insulin resistance. Recent short-term clinical trials have shown that 3 g to 4.5 g of salicylate therapy daily has the ability to lower insulin resistance and to reduce the levels of glucose, triglycerides, and free fatty acid concentrations through regulation of the I-κB kinase beta/NF-κB pathway, with few if any side effects. However, the effectiveness of salsalate as a treatment option for prediabetes is largely unrecognized. This article summarizes the current evidence from 3 studies of salsalate therapy in the setting of the prediabetic population and presents the case for its use in this population.

Conclusion: As shown in this review, salsalate therapy at the dose of 3 g to 4.5 g daily can lower insulin resistance and reduce the levels of glucose, triglycerides, and free fatty acid concentrations with minimal side effects. This inexpensive medication could be a useful option in the treatment of prediabetes. Larger clinical trials are needed, but the data are encouraging and should lay the foundation for further investigation and grant funding.