ABSTRACT
The appropriate use of second-generation oral hypoglycemic agents is limited by the lack of definitive guidelines for their use in elderly diabetic patients and controversy over relative dosing equivalence. We previously conducted a survey to determine the feasibility and cost of converting diabetic patients from glipizide to glyburide. This new survey provides an extended, 24-month follow-up in 210 patients and focuses on findings in elderly patients. The mean final daily dose of glyburide (11.6 mg) was lower than the preconversion dose of glipizide (18.7 mg) (P < or = 0.0001). One hundred forty-one (67%) patients successfully continued glyburide for 24 months, including 103 (73%) patients who were 65 years of age or older. There was no apparent correlation between age and final dose of glyburide, ability to continue glyburide, or risk of stopping glyburide. The conversion program reduced the mean daily dose after switching from glipizide to glyburide, which was preserved throughout the observation period. The program also conferred a 49% savings in the projected 2-year expenditures for second-generation oral hypoglycemic agents.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Glipizide/therapeutic use , Glyburide/therapeutic use , Health Services for the Aged/economics , Prescription Fees , Adult , Aged , Aged, 80 and over , Boston , Follow-Up Studies , Hospitals, Veterans , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Despite extensive clinical experience with second-generation oral hypoglycemic agents, the relative dosing equivalence of glyburide and glipizide remains controversial. A prospective survey was conducted to determine the feasibility and cost of converting noninsulin-dependent diabetic patients from glipizide to glyburide. A total of 211 patients previously stabilized on glipizide were converted to glyburide and returned to their respective clinics at least once during the following six months. The mean daily dose (+/- SD) of glipizide before conversion was 18.7 +/- 12.32 mg; the mean daily dose of glyburide after seven months was 9.9 +/- 6.52 mg (P less than 0.001, paired t test). Glyburide was well tolerated. The conversion program appeared to be successful and resulted in a 47% reduction in the mean daily dose after conversion from glipizide to glyburide, which, in turn, conferred a 43% savings in the projected yearly expenditures for second-generation oral hypoglycemics.
