SULFONYLUREA TREATMENT PREVENTS RECURRENCE OF HYPERGLYCEMIA IN OBESE AFRICAN-AMERICAN PATIENTS WITH A HISTORY OF HYPERGLYCEMIC CRISES

OBJECTIVE - Many newly diagnosed obese African-American patients with history of severe hyperglycemia or diabetic ketoacidosis (DKA) are abl e to discontinue pharmacological treatment with continued good metabol ic control. However, many of these individuals relapse into hyperglyce mia within 1 year. In such patients, we compared the effect of low-dos e sulfonylurea and dietary therapy in the prevention of recurrence of hyperglycemia. RESEARCH DESIGN AND METHODS - We conducted an intention -to-treat study in 35 obese newly diagnosed diabetic patients (17 with DKA and 18 with severe hyperglycemia). After discontinuation of insul in, seven of 17 patients with DKA and seven of 18 patients with hyperg lycemia were managed with diet and glyburide (1.25-2.5 mg/day), wherea s other patients were followed with diet alone. In all patients, pancr eatic insulin reserve was documented 1 day after resolution of hypergl ycemic crises and within 1 week of discontinuation of insulin. Recurre nce of hyperglycemia was defined as fasting blood glucose >7.8 mmol/l (140 mg/dl) or random blood glucose >10 mmol/l (180 mg/dl) on two or m ore consecutive determinations, or HbA(1c) >7.5%. RESULTS - Both treat ment groups were comparable in age, sex, duration of diabetes, months of insulin therapy, BMI, glucose, and HbA(1c). At presentation, the ac ute C-peptide response to glucagon in obese DKA, patients was lower th an in patients with hyperglycemia (P < 0.01), but responses were compa rable after discontinuation of insulin. Sulfonylurea treatment signifi cantly reduced recurrence of hyperglycemia in both obese DKA and obese hyperglycemic patients (P = 0.03). With a median follow-up of 16 mont hs, hyperglycemia recurred in six of 10 DKA patients and in five of 11 hyperglycemia patients treated with diet alone, compared with one of seven DKA and one of seven hyperglycemia patients treated with glyburi de. Readmission with metabolic decompensation occurred in four patient s treated with diet but in none of the patients treated with diet and glyburide. CONCLUSIONS - Low-dose sulfonylurea therapy prevents recurr ence of hyperglycemia in newly diagnosed obese African-American patien ts with a history of hyperglycemic crises.