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June 14, 1958


Author Affiliations


From the Joslin Clinic and the Baker Clinic Research Laboratory, New England Deaconess Hospital. Dr. Mehnert held a stipendium from Deutscher Akademischer Austauschdienst, Bonn, Germany. Dr. Camerini-Dávalos held a foreign fellowship, Eli Lilly & Company, Indianapolis.

JAMA. 1958;167(7):818-827. doi:10.1001/jama.1958.02990240018004

Factors favoring success with tolbutamide in the treatment of diabetes were sought in a study of 1,030 diabetic persons. There were 772 in whom it was deemed feasible to begin maintenance studies with tolbutamide alone. In 136 of these, trial indicated within a month that tolbutamide alone was inadequate (primary failure). In 407 patients in whom good control of hyperglycemia and glycosuria was obtained, important characteristics were that the onset of diabetes had usually occurred after the age of 40 years and that the insulin requirement was less than 20 units daily. In 40 patients results with tolbutamide became unsatisfactory after an earlier period of good control (secondary failure). A single-dose, four-hour response test was helpful in selection of patients for long-term maintenance therapy with the drug. There were only eight patients in whom the use of tolbutamide had to be stopped because of side-effects; the symptoms of toxicity were generally urticaria and minor digestive complaints. Histological examination of liver and pancreas was carried out in 2 of 12 patients who died of various causes during the period of observation; no evidence of damage attributable to the drug was obtained. Since tolbutamide is taken orally, it is especially welcome to patients handicapped by blindness or by other conditions which make self-injection difficult. It should not be used if dietary restriction alone will suffice or if tolbutamide is not effective and insulin is found necessary to provide good control.