This is the weaker of the two articles we reviewed on this topic. It appears to have relied, perhaps entirely, on a press release. The story adds no independent, critical thoughts to the official description of the published study.
It would have strengthened the piece to include a critique from a leading diabetologist who was not connected with the study. It also would have been good to describe the people included in the study in more detail. What was the average age, were men and women included, what other treatments were participants taking, etc.
It would indeed be valuable to have a new safe, effective, and inexpensive weapon to insert in the arsenal of diabetes combination therapy. But while this article touts this drug’s promise in diabetes and even heart disease, it omits the key points from the published study about the trial’s limitations and its identification of potential safety issues. The story would have done well to address the investigator’s stated rationale for why more studies are needed: "The drug’s long-term safety in this population, and particularly its effects on renal function, require further investigation."
The article notes that the drug is available generically and, if its use in diabetes is borne out in future trials, may represent an "inexpensive" treatment option.
By simply abstracting the press release, the article makes a significant error. Compare the following
The latter makes it sound like 100% of the salsalate groups had this result — or that the mean drop in the subjects who took salsalate was 0.5%. Neither interpretation is correct. In reality, 44%, 54%, and 60% of the subjects in each salsalate group (there were 3 doses) achieved at least a 0.5% drop, as did 15% of those who took placebo. If you look at the means compared to placebo, the mean reductions for the 3 salsalate doses were -0.36%, -0.34%, and -0.49%.
Let’s try to clear up the misinterpretation because the press release isn’t crystal on it either. The study looked at what proportion of people who took salsalate had at least a 0.5% reduction in their blood glucose. For comparison, they also looked at how many people who took a placebo pill had at least a 0.5% reduction in their blood glucose. The key is that it’s a comparison. It’s like asking "What proportion of people who ran the Chicago Marathon versus the New York Marathon finished in under 3 hours?" The study, in effect, found that more people who marathoned in Chicago instead of New York finished in under 3 hours. The article, in effect, twisted this result to imply erroneously that everyone in Chicago finished under 3 hours, or that the average time was under 3 hours.
The study also mentioned beneficial effects of salsalate on triglycerides and adiponectin, but these benefits were not quantified.
No safety information from the study is mentioned, only a crib from the press release that salsalate is "easier on the stomach" than aspirin. However, the drug needs long-term safety data specifically in this population, and the study revealed the potential for kidney effects.The investigators themselves explain in the published study that these two gaps, long-term safety data and the potential for renal impact, require more studies before the drug can be recommended in diabetes.
Channeling the press release, the story notes that the study was preliminary and that more studies are needed before the drug can be recommended for use in diabetes. However, we would have liked even one sentence evaluating the type and quality of the study: it was a small, short trial designed to compare 3 different doses to each other and to placebo.
The authors report a 0.5% reduction in A1c attributable to use of the medication. They talk about an additional potential benefit from a possible reduction in cardiovascular risk. If the study was not designed to measure this, it would be prudent to leave it out of the press release and story. Given how small the study was it would be useful to know if the observed reduction in A1c was a statistically significant difference. It also would have been helpful if the story would have provided an estimate of how often the worrisome renal side effects were observed.
Not applicable, in that the story really delivers no information about incidence or seriousness of diabetes.
No independent sources were used.
The investigators didn’t disclose any substantial conflicts of interest related to the study.
The press release, via this story, makes the confusing point that the A1C drop in this study "was in the range of several recently released diabetes treatments, according to the study." We see at least three problems with this quote.
Comparing the drug’s GI safety to that of aspirin is not directly relevant to this criterion because aspirin is not currently used to treat hyperglycemia.
The article is clear that the drug is widely available for arthritis, but not yet available for diabetes.
The article is clear that salsalate is a currently used for the treatment of arthritis but not yet recommended for the treatment of diabetes.
The article appears to rely, perhaps entirely, on a press release. All the quotes and even some of the characteristic language, such as "easier on the stomach," were in the release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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