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An analysis was made of the records of 1,840 patients in whom diabetes started after the age of 35 and before the age of 70, and who were under the authors' care for from one to fifteen years. According to the predictions of life‐insurance tables, these patients lived longer than non‐diabetic patients. There was a significant decrease in longevity in those who had persistent hyperglycemia. The greatest increase in longevity occurred in those whose disease could be controlled by diet alone or with sulfonylurea drugs. There was less apparent benefit from phenformin or insulin in this respect. In comparison, the findings of the University Group Diabetes Program are discussed in some detail. The authors' data indicate that, in the treatment of diabetes, sulfonylurea drugs have a beneficial effect upon longevity when they are used properly.

The search for the most potent and safest drug to be used in the oral treatment of diabetes has been continuous since the sulfonylurea drugs were first found to have hypoglycemic properties in 1942. Tolbutamide is the most widely used drug and its efficiency and safety has been attested by many reports.' It has been used in more than 400,OOO patients with a prolonged satisfactory therapeutic response in more than one half of the cases and with minimal toxicity. In our own series of 200 patients, we obtained initial improvement in 84 per cent? After 1 year of treatment this was reduced to 54.5 per cent: and after 2 years of treatment, to 46.5 per cent! This gives an over-all secondary failure rate of 38.5 per cent or about 3 per cent of those under treatment each month. This high rate of secondary failure is offset by a lower rate of primary failure than has been reported by others.' This difference is due to the fact that we continued to use the drug in 67 patients with initial poor or fair results. Our 46.5 per cent successful patients a t the end of 2 years is comparable with the 53.4 per cent reported by Mehnert et al.5 at the end of 20 months if all of their unselected patients are included as ours were.Chlorpropamide was introduced because the same hypoglycemic effect can be obtained with a smaller dosage.s I n our experience with 46 patients the comparable dose is about one third to one fourth that of tolbutamide, apparently due to a higher blood level resulting from the slower excretion. In general there is no significant difference in the results obtained with the two drugs. A few patients did show better results, but this can often be explained by the fact that it was easier for the patient to remember to take 2 or 3 tablets of chlorpropamide each morning than to try to remember to take 1 or 2 tablets of tolbutamide 2 to 4 times each day. When the drug is given in adequate doses any patient who does not respond well to one compound will not do well on the other. Since the dosage we used did not exceed 1 gm./day we did not encounter any patients with jaundice or other evidence of liver damage. There was one patient who had an aggravation of her anginal syndrome after being changed from tolbutamide to chlorpropamide, but this improved after the dose was reduced and the blood sugar allowed to rise.Metahexamide has been used in 70 patients with excellent results in 31, good results in 14, fair results in 2, and poor results in 23 (only 51 patients are shown in FIGURE 1). There were 32 patients who had been treated with tolbutamide or chlorpropamide previously. Of the 14 with satisfactory results in the past there were 9 excellent, 4 good, and 1 fair response. Of the 18 with unsatisfactory results in the past, there were 14 failures, 2 poor, and 2 fair response. These last four patients either had been secondary failures or poor results previously. They have not been followed long enough for complete evaluation. It can be seen that these results are similar to those obtained with the other sulfonylurea drugs ...

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