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Background Due to several limitations in the study designs of sulfonylurea pharmacogenomics studies, we investigated the clinical and genetic predictors of secondary sulfonylurea failure in type 2 diabetes patients. Materials methods Patients receiving the maximum sulfonylurea and metformin doses for 1 year were enrolled. Secondary sulfonylurea failure was defined as HbA1c 7.0% (53 mmol/mol) after a 12-month follow-up. Results By multivariate analysis, increased insulin resistance (HOMA2-IR), baseline HbA1c 7.0%,