Letter by Simard et al Regarding Article, “Sulfonylurea Use Before Stroke Does Not Influence Outcome”

To the Editor:Favilla and colleagues1 address the use of sulfonylureas in diabetic patients with stroke. The article deals with 2 important interrelated questions: first, a “safety question”—does prior use of sulfonylureas worsen stroke presentation or outcome? Second, an “efficacy question”—does prior use plus continued use of sulfonylureas during hospitalization for stroke favorably influence outcome? Given extensive preclinical evidence for the beneficial role of sulfonylureas in rodent models of stroke, and 2 prior retrospective analyses suggesting beneficial effects in patients with stroke when sulfonylureas are continued during hospitalization, it is important to assess the negative results from Favilla et al as it relates to the “efficacy question.” Important methodological considerations raise serious concerns about their conclusions.The “efficacy question” was studied previously by comparing diabetics who were on and continued on a sulfonylurea during hospitalization with diabetics not on a sulfonylurea. …