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August 27, 2003

Medications That Prolong the QT Interval

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(8):1026-1027. doi:10.1001/jama.290.8.1026-a

In Reply: Drs Mikhail and Cope point out that renal function is an important determinant of doing of insulin and oral agents. We did not discuss this because of space considerations. We believe that the issue of decreased clearance of insulin in advanced renal failure is relatively common knowledge among clinicians treating patients with diabetic nephropathy. However, the overall clinical impact as shown in 2 studies is relatively small and probably overestimated by "conventional wisdom."1,2 Certainly in patients with creatinine clearance reduced by 25% or more we agree that this dosing issue should be considered, and acute or progressive renal failure may precipitate hypoglycemia for the reasons discussed by Mikhail and Cope.