Assessment of Oral Therapy in Diabetes Mellitus.

EARLIER trials at Whittington Hospital confirmed the hypoglycaemic effects of tolbutamide (Wolff, Stewart, Crowley and Bloom, 1956), phenformin (Hall, Crowley and Bloom, 1958) and chlorpropamide (Granville-Grossman, Crawford, Crowley and Bloom, 1959). Since the inception of oral therapy, more than 400 diabetics at this hospital have been successfully treated with these agents for more than three months and many have been under continuous treatment in this way for several years. Sufficient experience has accrued to make useful a review of the outcome of treatment with these drugs, and in particular to inspect the extent to which relapse occurs in diabetics at first well controlled on this oral therapy. There is general agreement that oral therapy is most likely to offer effective control in those developing diabetes in adult life ("maturity onset"), in those of average or above average weight and in those whose urine is free from acetone. To put it another way, oral therapy is reg,arded as unlikely to be successful in young diabetics, in underweight diabetics or in those displaying ketoacidosis. However, more recent studies Save demonstrated that in some more severe diabetics phenformin and chlorpropamide were more effective when taken together than when taken separately (Bloom and Richards, 1961). In view of this, a prospective series of newly diagnosed diabetics has been treated with a combination of phenformin and chlorpropamide in an endeavour to determine the extent to which this combin,ation can widen the effective range of oral therapy.