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To the Editor: I disagree with 3 of the assertions that Dr Holmboe makes in his Clinical Applications article¹ about treatment of type 2 diabetes. First, he describes a patient with a random plasma glucose concentration of 480 mg/dL (27 mmol/L) and states that such a patient would require insulin. I believe that this patient would almost certainly respond to high doses of a sulfonylurea agent. I have treated more than 100 symptomatic patients with glucose levels of this magnitude, many of whom have had ketosis, a few with slightly lowered bicarbonate levels (down to 16 meq/L), and a fair number with significant weight loss. More than 90% of them do not require insulin. After 4 months, 6 of 55 patients² were lost to follow-up (4 patients had lost their health maintenance organization insurance and 2 would not comply with the recommended follow-up). Of the remaining 49 patients, 6 continued . . . [Full Text of this Article]

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