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April 3, 2002

Treatment Decisions for Type 2 Diabetes—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(13):1646-1648. doi:10.1001/jama.287.13.1645

In Reply: Dr Davidson argues that patient 1 does not need insulin and would most likely respond to a high-dose sulfonylurea agent. I agree that a sulfonylurea drug is an appropriate option for the initial and long-term care of this patient, as I stated in the article. However, the question is whether this patient should start therapy with insulin before switching to an oral agent. It was not my intention to suggest that initiating a short course of insulin therapy in a patient who has newly diagnosed diabetes and significant hyperglycemic symptoms was necessarily an emergency, but rather one option to help selected patients achieve more rapid control of hyperglycemic symptoms.1 Furthermore, insulin may potentially improve response to oral agents by reducing glucose toxicity.2 From an evidence-based point of view, insulin is still one of several appropriate therapeutic choices for this patient.3,4

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