Patient characteristics not described
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* Stanley Lofsky

Research based on administrative databases, such as that reported by Scot Simpson and associates,1 who investigated the dose–response relation between sulfonylurea drugs and death in a patient with type 2 diabetes mellitus, can demonstrate trends but may not provide sufficient detail about individual patient variables. In treating new-onset diabetes, many physicians might be expected to initially prescribe metformin for obese patients and glyburide for patients of normal weight.2 However, the research reported by Simpson and associates does not allow us to confirm or refute such possible trends. Is the greater mortality rate associated with glyburide partially attributable to the more severe insulin deficiency seen in normal-weight diabetic patients, rather than being related to the type of antidiabetic drug used?

Simpson and associates did not determine mortality rates for patients receiving dual metformin and glyburide therapy. Thus, there was no opportunity to observe any possible protective effect of combined therapy.

At a more practical level, this study may convince physicians to switch to other, less common sulfonylureas or thiazolidinediones. However, many patients covered by provincial drug plans may have limited access to payment for such drugs. Provincial drug programs will need to move quickly to accommodate such shifts in prescribing practice to avoid financial pressures on our patients.

## REFERENCES

1.  1. Simpson SH, Majumdar SR, Tsuyuki RT, et al. Dose–response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study. CMAJ 2006;174(2):169-74.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzQvMi8xNjkiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTc0LzEzLzE4NzQuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Cheng AYY, Fantus IG. Oral antihyperglycemic therapy for type 2 diabetes mellitus. CMAJ 2005;172(2):213-26.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzIvMi8yMTMiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTc0LzEzLzE4NzQuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)