Long-term Observations on Oral Hypoglycemic Agents in Diabetes: The Effect of Carbutamide and Tolbutamide

On the basis of a six-year investigation in which 9,214 diabetics were treated with oral agents, we were able to confirm the criteria for sulfonylurea therapy set forth by Bertram, Bendtfeldt and Otto. The obese patient with maturity-onset diabetes, over fifty years of age, is potentially the best candidate for sulfonylurea therapy. Carbutamide was proved more effective than tolbutamide in controlling diabetes with severe metabolic disturbance. Therefore all patients who could not be controlled with tolbutamide were shifted to carbutamide. This method showed that 15 per cent of the successfully controlled and 30 per cent of the secondary failures who had been treated with tolbutamide had to be placed on carbutamide to achieve temporary control. Allergic skin reactions were side effects encountered most frequently. These occurred in 3.6 per cent of cases treated with carbutamide and in 0.8 per cent treated with tolbutamide. The drug was discontinued at the first sign of an untoward reaction. Both drugs had a minimal effect on the blood count; in view of the limited number of cases we were not able to determine a significant statistical difference between the drugs in this respect. When comparing the death rate of our study group with that of the general population of West Berlin, we found that the sulfonylurea compounds do not affect the mortality rate of myocardial infarction or renal and hepatic failure.