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May 13, 1998

Hypoglycemia From Glipizide and Glyburide—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(18):1441-1443. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-18-jac80006

In Reply.—We agree with Dr Shorr's assertion that epidemiologic studies and controlled clinical trials should complement one another, but we may differ with him on how this synergism occurs. Epidemiologic studies are important for establishing associations and determining rates of events, but such studies are often confounded by the presence of multiple, uncontrolled variables that may impede interpretation of the data. For example, Shorr's epidemiologic study of serious hypoglycemia among elderly Medicaid enrollees in Tennessee identified recent hospitalization, advanced age, and African American ethnicity as independent risk factors, but it could not control for important confounders such as alcohol ingestion, physical activity, and renal function.1 Since serious hypoglycemia does occur among patients using sulfonylurea agents and since the prevalence of type 2 diabetes is growing rapidly, studies designed to elicit the specific mechanisms of sulfonylurea-induced hypoglycemia and to ultimately predict those patients who are unsuitable for sulfonylurea therapy are both appropriate and important. Controlled clinical trials are an essential tool in the effort to identify specific variables that may predispose patients to life-threatening hypoglycemia when sulfonylurea agents are used.

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