Clinical utility of oral hypoglycemic agents in the management of patients with noninsulin-dependent diabetes mellitus.

Clinical usage of the sulfonylurea drugs is based on experience in well-controlled long-term studies in large numbers of patients. The results of such studies indicate that approximately 60 to 70 percent of the patients with noninsulin-dependent diabetes mellitus of recent onset will respond initially to sulfonylurea therapy with satisfactory control of glycemia, about 15 to 20 percent will not respond initially (primary failures), and another 15 to 20 percent who respond initially will lose their responsiveness during the first few years of treatment (secondary failures). In extensive studies in small numbers of patients, we found that successful management of noninsulin-dependent diabetes mellitus with glipizide was correlated with increased insulin responsiveness and that patients who did not have an increase in their insulin-mediated glucose disposal during glipizide therapy were primary failures. Successful treatment of noninsulin-dependent diabetes mellitus with sulfonylureas is associated with onset of of the disease at 40 years of age or later, normal or increased body weight, duration of disease less than five years, and a history of either no previous insulin therapy or therapy with less than 20 units of insulin per day. The use of specific sulfonylurea drugs is predicated on differences in their metabolism, side effects, and perhaps potency.