Electronic letters to:

Research:
Scot H. Simpson, Sumit R. Majumdar, Ross T. Tsuyuki, Dean T. Eurich, and Jeffrey A. Johnson
Dose–response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study
CMAJ 2006; 174: 169-174 [Abstract] [Full text] [PDF]
*eLetters: Submit a response to this article

Electronic letters published:

[Read eLetter] Patient characteristics not described
Stanley Lofsky   (3 April 2006)

Patient characteristics not described 3 April 2006
Top
Stanley Lofsky

Send letter to journal:
Re: Patient characteristics not described

slofsky{at}sympatico.ca Stanley Lofsky

Administrative database research is capable of demonstrating trends but is not capable of describing individual patient variables. Many physicians with a new case of diabetes would treat more obese patients initially with metformin, and normal weight patients with glyburide. This research gives us no patient details to corroborate such possible trends. Is the increased mortality with glyburide partially attributable to a more severe insulin deficiency seen with normal weight diabetics, rather than attributable to the type of antidiabetic used?

The study did not measure mortality of individuals on dual metformin and glyburide therapy. Thus there was no opportunity to measure any possible protective effect of combined therapy.

On a more practical basis, the research may convince physicians to switch to other less common sulfonylureas or thiazolidinediones. For many patients covered by Provincial drug plans, there may be limited access for payment. Provincial drug programs will need to move quickly to accomodate such pressures so as not to cause financial pressures on our patients.