Early Pharmacotherapy in Non-Insulin-Dependent Diabetes Mellitus: Help or Hindrance?-Reply

In Reply—  In our study,¹ we showed that a majority of obese patients with non-insulin-dependent diabetes mellitus who lost 9.1 kg of body weight failed to improve their blood glucose levels and that patients in whom blood glucose levels came down after a weight loss of 9.1 kg often improved with as little weight loss as 2.3 kg. We recommended pharmacologic treatment (oral hypoglycemic agents or insulin) for patients who fail to improve their blood glucose level after weight loss (and for those who fail to lose weight). We have not studied the results in nonresponders, but we expect that there are differences in the safety and efficacy of these therapies. Sheehan raises several points in favor of oral hypoglycemic agents over insulin therapy for this group of patients, but convincing data are lacking. Clearly, additional information is needed to guide the clinician in selecting treatment in this common