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To the Editor.—The study by Dr Burge and colleagues¹ was designed to compare blood glucose levels following a prolonged fast among older persons exposed to glyburide and glipizide. The study is justifiable because glipizide, manufactured by the study sponsor, may stimulate less insulin secretion in the fasting state and may, therefore, produce less hypoglycemia following a prolonged fast than does glyburide.² Also, there is a 2-fold increase in the risk of serious hypoglycemia among older adults prescribed glyburide compared with glipizide.³ In this experimental setting, there were no differences in fasting glucose levels between glyburide and glipizide and no hypoglycemia occurred among study participants.

Epidemiologic studies have demonstrated a 1 to 2 per 100 person-years risk of serious hypoglycemia among users of sulfonylureas, with glyburide exhibiting higher rates than other sulfonylureas.^3-4 In our population-based studies of older Tennessee Medicaid enrollees, the incidence of hypoglycemia requiring emergency department evaluation or . . . [Full Text of this Article]