Glucose-Lowering Effects of Sulfasalazine in Type 2 Diabetes

Abstract

Salicylates are therapeutic agents clinically useful in treating inflammatory bowel diseases and arthropathies. These drugs have also demonstrated glucose-lowering effects in type 2 diabetes (1–2). Sulfasalazine (SSZ) is a compound that is cleaved in vivo to 5-aminosalicylic acid (a salicylate) and sulfapyridine (a sulfonamide antibiotic). We report a case of a patient with systemic lupus erythematosus (SLE) and type 2 diabetes on high-dose insulin therapy, who after initiating SSZ experienced recurrent severe hypoglycemia and eventually achieved normoglycemia without the need for diabetes medications. After caring for the index patient, and then two others manifesting similar metabolic responses to SSZ, we conducted a systematic chart review to evaluate glycemic effects of SSZ in a cohort of diabetic patients. A 37-year-old woman with SLE, iron-deficiency anemia, metamphetamine usage, and a 1-year history of type 2 diabetes was referred to the Santa Clara Valley Medical Center (SCVMC) diabetes clinic for treatment of severe hyperglycemia. She took 100 units of insulin daily (NPH 35 units b.i.d., regular 10 units t.i.d.), yet her self-monitored blood glucose (SMBG) values consistently exceeded 16.7 mmol/l, and she experienced polyuria/dipsia and blurry vision. Other medications were prednisone 7.5 mg/day and hydroxychloroquine. On examination, the patient was cachexic, weighing 44 kg. Laboratory evaluation revealed normal …