Pills for Diabetes

For as long as 2 1/2 years, hundreds of thousands of diabetics all over the world have been treated with tablets of tolbutamide instead of insulin injections. Many have rejoiced at their new-found freedom from the need for daily needlework. Last week the Upjohn Co. (which markets the drug as Orinase) decided to lay on the line just what it will and will not do. To its Kalamazoo headquarters Upjohn invited 500 physicians to hear reports from Germany's Dr. Ernst Pfeiffer, one of the first investigators to use the drug, and from Chicago's Dr. Rachmiel Levine, one of the world's top researchers into the mysteries of sugar metabolism.

Of 758 patients treated since the late summer of 1955 at Frankfurt's University Medical Clinic, said Dr. Pfeiffer, 78% achieved good control of their diabetes, and the benefit shows every sign of lasting. (Tolbutamide is not a substitute for the body's natural insulin. It apparently achieves its effect by boosting the release into the blood stream of insulin, which, in most adult patients, continues to be secreted by the pancreas.) Tolbutamide did no good from the start in 8% of cases. In a further 8% it had to be dropped because early good results wore off. A few patients gave it up because of side effects, usually skin rashes, nausea and vomiting. It caused no serious illnesses.*

Other highlights of the Pfeiffer-Levine reports:

P: No adult diabetic should get long-term treatment with either insulin or tolbutamide until he has reduced to a proper weight and it has been shown that diet alone will not control the diabetes.

P: Tolbutamide is useless for patients who get diabetes before they are about 25. (The pancreas then appears to lose all power to secrete insulin and injections are necessary.) It is usually ineffective for those who get diabetes before 40.

P: In patients whose diabetes has developed in later life, a good rule of thumb is that if they need more than 40 units of insulin daily tolbutamide will not do the job alone. In some cases it can be used alongside continued, but smaller, insulin injections. It is not suitable for patients whose disease fluctuates widely.

Even with these exclusions, indications are that tolbutamide could control diabetes in approximately half the estimated 3,000,000 U.S. cases.

*Another German compound, carbutamide, was abandoned in the U.S. by Eli Lilly & Co. because it caused liver damage, was suspected of speeding the deaths of eight patients.

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