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Comment & Response |

Insulin vs Sulfonylureas for Second-Line Diabetes Treatment—Reply

Christianne L. Roumie, MD, MPH1; Robert A. Greevy, PhD2; Marie R. Griffin, MD, MPH3
[+] Author Affiliations
1Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, HSR&D Center, Nashville
2Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
3Department of Health Policy, Vanderbilt University, Nashville, Tennessee
JAMA. 2014;312(16):1693-1694. doi:10.1001/jama.2014.11120.
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In Reply We agree with Drs Tasci and Safer that the risk of metformin and insulin compared with metformin plus sulfonylurea as a second-line diabetes treatment after failure of metformin monotherapy may differ in certain populations. They point to eFigure 3 that shows a statistically significant increased risk in persons aged 65 years or older and no statistically significant increase in younger persons.

However, the confidence intervals for the HRs in the 2 age groups have considerable overlap and a formal test for interaction between metformin plus insulin and age is not significant (P = .22). Thus, we have not proven significant differences in risk by age. The numerical differences observed could represent real differences or simply chance variation in the estimated associations.


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October 22, 2014
Ilker Tasci, MD; Umut Safer, MD
1Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
JAMA. 2014;312(16):1693. doi:10.1001/jama.2014.11114.
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