Clinical experience with phenformin timed disintegration capsules in Indian diabetics.

THE treatment of diabetes mellitus by oral drugs has found general acceptance. Phenformin hydrochloride with a mechanism of action different from that of the sulphonylureas, has been widely used in the Western countries during the last five years and has already acquired a reputation of being an effective drug in the treatment of primary or secondary failures to sulphonylureas and in the smooth control of brittle diabetes (Stowers, 1962; Weller, Donesa and Morton, 1962; Fabrykant and Ashe, 1961; Beaser, 1960; Bloom, Newton and Bateman, 1964). The nature of the response however depends besides other factors on the type of the disease. In India the pattern of diabetes mellitus appears to be slightly different. That the disease in the tropic differs from that in temperate climate has also been stressed earlier (Hugh-Jones, 1955; Cosnett, 1959; DeZoysa, 1951). The classical growth-onset type of the disease is relatively rare. In our clinic amongst 329 patients observed during the last one and a half years only five cases of juvenile diabetes were encountered and none of them was below 10 years of age. The extremely low incidence of juvenile diabetes in the tropics was also stressed by DeZoysa, of Ceylon (1951). However the maturity-onset type of diabetes is quite as common as in Western countries, the only difference being that obesity amongst them is relatively rare, most of them being average weight individuals. Besides these two classical types we have come across diabetes with age of onset between 20 and 40 years differing in some respects from the other groups. Predominantly males, they are usually thin individuals who can remain without insulin for several days with no untoward manifestations. In other words, they are relatively ketoacidosis resistant though they may rarely suffer from this, under extraordinary stressful circumstances. They are also relatively insulin resistant and may require