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James C. Breneman, M.D.
JAMA. 1957;164(6):627-633. doi:10.1001/jama.1957.02980060003002.
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• Tolbutamide was administered orally to 45 patients with various types of diabetes. The patients in one group, consisting of new diabetics and of old diabetics who had refused insulin, were instructed to live as they had before except to take one 0.5-Gm. tablet four times daily. A second group, consisting of patients who had used repository types of insulin, went without insulin or other medication for four days before starting the use of tolbutamide. A third group of patients who had been taking insulin reduced their insulin intake by 25% while increasing the dosage of tolbutamide by 0.5 Gm. each day until the use of insulin was stopped and the dosage of tolbutamide was 2.0 Gm. daily. Five patients proved to have the juvenile type of diabetes and showed no evidence of control by tolbutamide. Four patients who still depended on insulin responded to the tolbutamide by a significant reduction of their insulin requirements. Thirty-six patients were classified as excellent responders in that tolbutamide proved sufficient for diabetic control. All good and excellent responders were in their late 30's when their diabetes was discovered; they were generally obese, and women responded more frequently than men. Side-effects of transient, subjective nature have been reported by four patients but have not been noted in eight others after more than 11 months of tolbutamide therapy. The drug was most useful in mild, uncomplicated cases of diabetes developing after the age of 30 years in somewhat obese patients.


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