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August 3, 1970

The Tolbutamide Controversy

JAMA. 1970;213(5):861. doi:10.1001/jama.1970.03170310139047

Physicians attending the annual meeting of the American Diabetes Association in St. Louis on June 14,1970, heard the report of an eight-year prospective study on "The Effect of Hypoglycemic Agents on Vascular Complications in Patients With Adult-Onset Diabetes" conducted by the University Group Diabetes Program under the sponsorship of the National Institute for Arthritis and Metabolic Diseases of the National Institutes of Health. Comments on most of the report will not be offered at this time, but the finding that treatment with tolbutamide is associated with substantially higher death rates from cardiovascular disease than is treatment with diet alone or with diet and insulin, calls for editorial reaction. The premature publication of this finding, "leaked" to the press in May by an unidentified source, caused consternation among both physicians and diabetic patients.

Although recognizing the care with which this study was designed and carried out, we must sound a cautionary