A new generation of oral hypoglycemics. Their use, measurement, and effects on insurance risk assessment

The increased use of oral hypoglycemics among the more than 14 million diabetics in the United States and the development of new pharmaceutical formulations requires the continued surveillance of their use in the insurance applicant population. Routine monitoring of urine glucose or even blood glucose or fructosamine measurements often fail to detect the diabetic using oral hypoglycemics. Urine analysis for the use of first generation sulfonylureas has shown a declining prevalence of their use due to the increased number of prescriptions written for newer and more effective drugs. In order to monitor the use of these second-generation oral hypoglycemics, an immunoassay was developed to detect the use of glyburide, 1-[4-[2-(5 chloro-2-methoxybenzamido) ethyl]-phenyl] sulfonyl]-3-cyclohexylurea. After testing in a defined population of known users of this class of sulfonylureas, the assay was applied to a random population of 12,000 applicants applying for life insurance. Results demonstrate the predictive value of this assay in determining the prevalence of use of this drug in the insurance-buying population and its assistance in risk assessment.