Maximal dose glyburide therapy in markedly symptomatic patients with type 2 diabetes: a new use for an old friend.
Abstract
No consensus exists as to the best approach for treating markedly symptomatic patients with new-onset (or diet-treated) type 2 diabetes. Therefore, based on the experience of one successful case, further studies were undertaken to determine the safety and efficacy of maximal dose glyburide (10 mg, twice daily, in patients < 65 yr of age) or half the dose (10 mg, daily, in patients > or = 65 yr of age) for treating these patients. Fifty-five patients with polyuria, polydipsia, nocturia, involuntary weight loss, and blood glucose concentrations of 300 mg/dL or greater were treated following protocols that used maximal dose ( < 65 yr of age) or half-maximal dose ( > or = 65 yr of age) sulfonylurea agent therapy. Data were collected retrospectively in 30 patients and prospectively in 25. Patients in the prospective group differed only in that more laboratory measurements were obtained, and less strict guidelines for using insulin were adopted. Data were collected in both groups at baseline and 1 week and 4 months after starting the sulfonylurea agent therapy. Patients responded rapidly with a fall in blood glucose levels from 456 +/- 12 mg/dL at baseline to 202 +/- 10 mg/dL at 1 week to 120 +/- 5 mg/dL at 4 months. Glycated hemoglobin levels fell from 18.1 +/- 0.4% at baseline to 8.1 +/- 0.2% ( P < 0.0001) at 4 months. Most patients had symptomatic improvement within 3 days. Seventeen patients had positive (small or larger) urinary ketones, and 5 had positive serum ketones. Insulin to glucose and C peptide to glucose ratios improved maximally at 1 week, indicating rapid reversal of glucotoxicity on the beta-cell. At 4 months, 11 patients were receiving diet therapy alone, 29 were receiving submaximal dose sulfonylurea agent therapy, 6 remained on maximal dose sulfonylurea agent therapy, and only 3 were receiving insulin therapy. Six patients were lost to follow-up. No patient experienced hypoglycemia in the first 2 weeks of treatment. Maximal dose sulfonylurea agent therapy is a safe and effective method for treating patients with markedly symptomatic type 2 diabetes. Patients improve rapidly and are able to avoid the immediate institution of long term insulin therapy.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients with recent-onset diabetes often respond adequately to less intensive interventions than those with longer-term disease.
“however, patients with recent-onset diabetes often respond adequately to less intensive interventions than those with longer-term disease (48).”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [48]
Many newly diagnosed type 2 diabetic patients will usually respond to oral medications, even if symptoms of hyperglycemia are present.
“However, many newly diagnosed type 2 diabetic patients will usually respond to oral medications, even if symptoms of ehyperglycemia are present (48).”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [48]
Cited by
Sorted by citations
Nathan, D. M., Buse, J. B., Davidson, M. B., Ferrannini, E., Holman, R. R., Sherwin, R., & Zinman, B. (2009) · Diabetes Care · doi:10.2337/dc08-9025 · Cited by 3,834 · see citing works
“However, many newly diagnosed type 2 diabetic patients will usually respond to oral medications, even if symptoms of ehyperglycemia are present (48).”
BackgroundSelf-citationNathan, D. M., Buse, J. B., Davidson, M. B., Ferrannini, E., Holman, R. R., Sherwin, R., & Zinman, B. (2009) · Diabetologia · doi:10.1007/s00125-008-1157-y · Cited by 712 · see citing works
“However, many newly diagnosed type 2 diabetic patients will usually respond to oral medications, even if symptoms of hyperglycaemia are present [48].”
Self-citationPathogenesis of Type 2 Diabetes Mellitus
Leahy, J. L. (2005) · Archives of Medical Research · doi:10.1016/j.arcmed.2005.01.003 · Cited by 469 · see citing works
Drug Treatment of Non-Insulin-Dependent Diabetes Mellitus in the 1990s
Scheen, A. J. (1997) · Drugs · doi:10.2165/00003495-199754030-00001 · Cited by 171 · see citing works
Early Insulin Treatment in Type 2 Diabetes
Meneghini, L. (2009) · Diabetes Care · doi:10.2337/dc09-s320 · Cited by 53 · see citing works
“Improvements in -cell function and insulin action have also been reported when euglycemia is achieved with noninsulin therapies (19).”
BackgroundNathan, D. M., Buse, J. B., Davidson, M. B., Ferrannini, E., Holman, R. R., Sherwin, R., & Zinman, B. (2009) · Diabetes Spectrum · doi:10.2337/diaspect.22.1.6 · Cited by 39 · see citing works
“When levels of glycemia are high (e.g., A1C 8.5%), classes with greater and more rapid glucose-lowering effectiveness, or potentially earlier initiation of combination therapy, are recommended; however, patients with recent-onset diabetes often respond adequately to less intensive interventions than those with longer-…”
BackgroundInfluentialSelf-citationBabu, A., Mehta, A., Guerrero, P., Chen, Z., Meyer, P. M., Koh, C. K., Roberts, R., Schaider, J., & Fogelfeld, L. (2009) · Endocrine Practice · doi:10.4158/ep09117.orr · Cited by 34 · see citing works
Jönsson, A., Hallengren, B., Rydberg, T., et al. (2001) · Diabetes Obesity and Metabolism · doi:10.1046/j.1463-1326.2001.00152.x · Cited by 30 · see citing works
Pharmacotherapy of Type 2 Diabetes Mellitus
Rendell, M., & Kirchain, W. R. (2000) · Annals of Pharmacotherapy · doi:10.1345/aph.19171 · Cited by 30 · see citing works
Insulin Therapy: A Personal Approach
Davidson, M. B. (2015) · Clinical Diabetes · doi:10.2337/diaclin.33.3.123 · Cited by 29 · see citing works
Self-citationNathan, D. M., Buse, J. B., Davidson, M. B., Ferrannini, E., Holman, R. R., Sherwin, R., & Zinman, B. (2009) · Clinical Diabetes · doi:10.2337/diaclin.27.1.4 · Cited by 29 · see citing works
Self-citationBermúdez, V., Cano, R., Cano, C., Bermúdez, F., Leal, E., Acosta, K., Mengual, E., Arráiz, N., Briceño, C., Rivas, J. G., et al. (2008) · American Journal of Therapeutics · doi:10.1097/mjt.0b013e318160b909 · Cited by 26 · see citing works
Magee, M. F., Nassar, C. M., Mete, M. Y., White, K., Youssef, G. A., & Dubin, J. S. (2015) · Endocrine Practice · doi:10.4158/ep15655.or · Cited by 23 · see citing works
Pathogenesis of Type 2 Diabetes Mellitus
Leahy, J. L. (2008) · Humana Press eBooks · doi:10.1007/978-1-60327-043-4_2 · Cited by 24 · see citing works
Early Insulin Therapy for Type 2 Diabetic Patients: More Cost Than Benefit
Davidson, M. B. (2005) · Diabetes Care · doi:10.2337/diacare.28.1.222 · Cited by 22 · see citing works
“For instance, even in markedly symptomatic type 2 diabetic patients (on no other antidiabetes medications), maximal sulfonylurea agent therapy accomplished the same thing (32).”
BackgroundSelf-citationSynthetic Protection Short Interfering RNA Screen Reveals Glyburide as a Novel Radioprotector
Jiang, J., McDonald, P. R., Dixon, T. M., et al. (2009) · Radiation Research · doi:10.1667/rr1674.1 · Cited by 20 · see citing works
“The maximal tolerated dose of glyburide has been established as 10 mg, twice daily, in patients ,65 years old or half the dose, 10 mg, daily, in patients $65 years old (24).”
BackgroundSynergy to Reduce Emergency Department Visits for Uncontrolled Hyperglycemia
Magee, M., Nassar, C., Copeland, J., Fokar, A., Sharretts, J., Dubin, J., & Smith, M. S. (2013) · The diabetes educator · doi:10.1177/0145721713484593 · Cited by 15 · see citing works
“Two early reports suggested that maximal dose sulfonylurea is safe and effective for treating such patients and could avoid need for hospital admission.(10,11) A more recently reported randomized study found that sulfonylurea with or without 10 units of insulin glargine improved blood glucose (BG) levels in type 2 dia…”
BackgroundAmblee, A., Lious, D., & Fogelfeld, L. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-4097 · Cited by 16 · see citing works
“Sulfonylureas were successful in lowering BG levels in patients with severe hyperglycemia in one combined retrospective/prospective study (4, 5).”
BackgroundEstablished Therapies for Diabetes Mellitus
Hsia, S. H., & Davidson, M. B. (2002) · Current Medical Research and Opinion · doi:10.1185/030079902125000192 · Cited by 15 · see citing works
Self-citationSaeed, M., Sharif, A., Hassan, S. U., Akhtar, B., Muhammad, F., & Malik, M. (2021) · Environmental Science and Pollution Research · doi:10.1007/s11356-021-15917-9 · Cited by 13 · see citing works
“The selection of the medicinal agent is based upon the prevalence of the disease, age, sex, body mass index, and other disease factors (Peters and Davidson 1996).”
BackgroundKoufakis, T., Karras, S. Ν., Zebekakis, P. E., Ajjan, R., & Kotsa, K. (2018) · Expert Opinion on Biological Therapy · doi:10.1080/14712598.2018.1526278 · Cited by 12 · see citing works
“[54], 55 highly symptomatic, drug-naïve T2DM patients who presented with >400 mg/dl (22.”
Sen, A. K., Sarkar, T., Sen, D. B., Maheshwari, R. A., Zanwar, A. S., & Dumpala, R. L. (2024) · Separation Science Plus · doi:10.1002/sscp.202400059 · Cited by 11 · see citing works
Imam, S. K. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-800093-9.00003-x · Cited by 8 · see citing works
Treatment Decisions for Type 2 Diabetes
Davidson, M. B. (2002) · JAMA · doi:10.1001/jama.287.13.1646 · Cited by 4 · see citing works
Self-citationSherman, L. D., & Fawole, T. (2016) · American Journal of Men s Health · doi:10.1177/1557988316642274 · Cited by 6 · see citing works
Davidson, M. B. (2009) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e328322f92e · Cited by 5 · see citing works
Self-citationGlibenclamide Therapy in Type 2 Diabetes
Sai Laxmi, M., Venkatesham, A., Reddy, A. R. N., et al. (2009) · International Journal of Pharmaceutical Sciences and Nanotechnology · doi:10.37285/ijpsn.2009.2.1.11 · Cited by 3 · see citing works
Modern pharmacotherapies for type 2 diabetes mellitus.
Hsia, S. H. (2001) · PubMed Central · Cited by 2 · see citing works
Treatment of Non-Insulin-Dependent Diabetes Mellitus
Davidson, M. B. (1997) · Mayo Clinic Proceedings · doi:10.4065/72.1.92 · Cited by 2 · see citing works
Self-citationHow to start insulin treatment: Earlier or delayed insulin therapy
Akalın, S. (2006) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2006.06.008 · Cited by 1 · see citing works
“1% [18].”
Treatment of Non-Insulin-Dependent Diabetes Mellitus: In Response
NELSON, R. L. (1997) · Mayo Clinic Proceedings · doi:10.4065/72.1.92-a
Therapy of Type 2 Diabetes Mellitus
Bloomgarden, Z. T. (2004) · Springer eBooks · doi:10.1007/978-1-4757-6260-0_32
Paretoʼs Law and Sulfonylureas
Peiris, A. N., Micklewright, M., & Gangadharan, V. (2007) · Southern Medical Journal · doi:10.1097/smj.0b013e318158b98c
Assessment of putative risk factors in the development of Diabetic Retinopathy in Wales
Chowdhury, S. R. (2016) · ORCA Online Research @Cardiff (Cardiff University)
- Authors
- Peters, A. L., & Davidson, M. B.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1996-07
- Volume
- 81
- Issue
- 7
- Pages
- 2423-2427
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2082849776
- Cited by
- 37
- References
- 0
- Citations by year
- 2024: 2 · 2021: 1 · 2018: 1 · 2016: 3 · 2015: 2 · 2014: 1 · 2013: 1
- FWCI
- 1.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- glibenclamide, type 2 diabetes, hyperglycemia, glucotoxicity, beta-cell function, HbA1c, ketosis, hypoglycemia, elderly patients, new-onset diabetes, polyuria and polydipsia, insulin/glucose ratio
- MeSH terms
- Adolescent, Adult, Aged, Blood Glucose, C-Peptide, Diabetes Mellitus, Type 2, Female, Glyburide, Humans, Hypoglycemic Agents, Insulin, Ketones, Male, Middle Aged, Polyuria, Prospective Studies, Retrospective Studies, Urination Disorders, Weight Loss
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
