Authors: Alan N. Peiris, MD, PhD, MRCP(UK), Melinda Micklewright, BSPharm, BCPS, Venkataramanan Gangadharan, MD
Italian economist Vilfredo Pareto observed that 80% of income in Italy went to only 20% of the population. Since then, the universality of this 80–20 rule has been widely recognized. One such application is sulfonylurea dose responses in the treatment of diabetes, with the majority of benefit coming from small introductory doses as elegantly shown by Rambiritch et al.1 Clinical practitioners using sulfonylureas have seen both sides of the dosage spectrum. Peters2 reported benefit from using maximal dose glyburide therapy in markedly symptomatic patients with type 2 diabetes, while Stenman3 reported that minimal doses of glipizide were effective and larger doses may actually induce deterioration in beta cell response.
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