Factors of primary and secondary sulfonylurea failure in type 2 diabetic subjects

The aim of the present study was to investigate the value of clinical characteristics in predicting sulfonylurea (SU) treatment responses.

All 747 subjects in the present study were from the Xiaoke Pill Clinical Trial evaluating the safety and efficacy of SU. Subjects had the same initial dose of glibenclamide and drug doses were adjusted every 4 weeks during the 48-week follow-up period. Primary SU failure was defined as a <10% reduction in fasting plasma glucose (FPG) at the end of Week 4 from randomization, whereas secondary SU failure was defined as a consecutive confirmed level of FPG >7 mmol/L.

Kaplan-Meier survival analysis revealed that lower baseline basal disposition index (DI _b ) and higher FPG predict secondary SU failure. Inversely, higher baseline DI _b and lower FPG predict primary SU failure. Primary SU failure can predict secondary SU failure. The combination of lower baseline DI _b with primary SU failure is a better predictor of secondary SU failure than lower baseline DI _b or primary SU failure alone.

Patients with good glycemic control and higher β-cell reserve at entry are more likely to experience primary SU failure but are less likely to experience secondary SU failure. By combining baseline DI _b with initial response at the first month of treatment, we can get quick information about the long-term efficacy of SU treatment.