Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization

Jacobson, George; Ramos, Gladys A.; Ching, Jenny; Kirby, Russell S.; Ferrara, Assiamira; Field, D R

doi:10.1016/j.ajog.2005.03.018

Cited by 172 publications

(120 citation statements)

References 11 publications

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“…In our study, 16% of those treated with glyburide failed the therapy and this is comparable to recent published reports. 9,[14][15][16][17][18] The glyburide group had a higher proportion of neonates diagnosed with hypoglycemia in our bivariate analysis. This finding did not remain statistically significant in a multivariable model after controlling for age, BMI and ethnicity.…”

Section: Discussionmentioning

confidence: 99%

“…Forty-six women (30 insulin; 16 glyburide) who met the above diagnostic criteria were reported previously in a study of the same KPNC population that used the more traditional diagnostic criteria for GDM. 9 General management of patients diagnosed with GDM included: nutritional counseling regarding a diabetic diet during pregnancy with three meals and three snacks and instruction on self-monitoring capillary blood glucose with a glucometer. Patients were advised to monitor blood sugars four times a day: fasting and either 1 or 2 h post-prandials (per individual provider preference) for breakfast, lunch and dinner.…”

Section: Methodsmentioning

confidence: 99%

“…A randomized trial by Langer et al and a retrospective study by Jacobson et al concluded that glyburide was an effective alternative to insulin for the treatment of gestational diabetes, 8,9 although both studies were underpowered to detect differences in some of the more rare neonatal outcomes. Despite limited clinical studies, recent expert opinion has suggested glyburide as an alternative first choice for GDM and a survey in 2003 found that 13% of obstetrician-gynecologists begin with glyburide for patients requiring therapy beyond diet.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia

et al. 2007

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Objective: To compare the effectiveness of glyburide and insulin for the treatment of Gestational diabetes mellitus (GDM) in women who had OGCT X200 mg/dl and fasting hyperglycemia.Study design: A retrospective study was performed among a subset of women treated with glyburide or insulin for GDM from 1999 to 2002 with an OGCT X200 mg/dl and pretreatment fasting plasma glucose X105 mg/dl. Exclusion criteria included pretreatment fasting X140 mg/dl, gestational age X34 weeks and multiple gestation. Maternal and neonatal outcomes were assessed. Statistical methods included bivariate and multivariable logistic regression analyses.Results: In 1999 to 2000, 78 women were treated with insulin; in 2001 to 2002, 44 of 69 (64%) received glyburide. There were no statistically significant differences between the two groups with regards to mean OGCT (230±25 vs 223±23 mg/dl, P ¼ 0.07) and mean pretreatment fasting (120±10 vs 119±11 mg/dl, P ¼ 0.45). Seven women (16%) failed glyburide. Women in the insulin group were younger (31.5±5.8 vs 35.2±4.7 years, P<0.001) and had a higher mean BMI (32.4±6.4 vs 29.1±5.8 kg/m 2 , P ¼ 0.003) compared to glyburide group. There were no significant differences in birth weight (3524±548 vs 3420±786 g, P ¼ 0.65), macrosomia (19 vs 23%, P ¼ 0.65), pre-eclampsia (12 vs 11%, P ¼ 0.98) or cesarean delivery (39 vs 46%, P ¼ 0.45). Neonates in the glyburide group were diagnosed more frequently with hypoglycemia (34 vs 14%, P ¼ 0.01). When controlled for confounders, macrosomia was found to be associated with glyburide treatment (OR 3.5, 95% CI 1.1 to 11.4). Conclusion:In women with GDM who had a markedly elevated OGCT and fasting hyperglycemia, glyburide achieved similar birth weights and delivery outcomes but was associated with an increased risk of macrosomia. The possible increased risk of neonatal hypoglycemia in the glyburide group warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia

et al. 2007

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“…In vitro studies suggested that transfer across the placenta was minimal 12, 13, 14 and glibenclamide was undetectable in cord blood 15. Early clinical studies suggested there was no significant increase in macrosomia or neonatal hypoglycaemia with the use of glibenclamide compared to insulin use 15, 16, 17, 18, 19, 20, but these studies were limited in their power to demonstrate differences 21. In a meta‐analysis (10 studies on 471 women exposed to sulfonylureas and biguanides in the first trimester), no significant difference was found in the rate of major malformations or neonatal death in the offspring of women with exposure to oral antidiabetic agents in the first trimester compared with non‐exposed women, but the meta‐analysis was limited by study heterogeneity 22.…”

Section: Sulfonylurea Treatment In Pregnancy In Type 2 Diabetes and Gmentioning

confidence: 99%

Management of sulfonylurea‐treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer

et al. 2017

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The optimum treatment for HNF1A/HNF4A maturity‐onset diabetes of the young and ATP‐sensitive potassium (KATP) channel neonatal diabetes, outside pregnancy, is sulfonylureas, but there is little evidence regarding the most appropriate treatment during pregnancy. Glibenclamide has been widely used in the treatment of gestational diabetes, but recent data have established that glibenclamide crosses the placenta and increases risk of macrosomia and neonatal hypoglycaemia. This raises questions about its use in pregnancy. We review the available evidence and make recommendations for the management of monogenic diabetes in pregnancy. Due to the risk of stimulating increased insulin secretion in utero, we recommend that in women with HNF1A/ HNF4A maturity‐onset diabetes of the young, those with good glycaemic control who are on a sulfonylurea per conception either transfer to insulin before conception (at the risk of a short‐term deterioration of glycaemic control) or continue with sulfonylurea (glibenclamide) treatment in the first trimester and transfer to insulin in the second trimester. Early delivery is needed if the fetus inherits an HNF4A mutation from either parent because increased insulin secretion results in ~800‐g weight gain in utero, and prolonged severe neonatal hypoglycaemia can occur post‐delivery. If the fetus inherits a KATP neonatal diabetes mutation from their mother they have greatly reduced insulin secretion in utero that reduces fetal growth by ~900 g. Treating the mother with glibenclamide in the third trimester treats the affected fetus in utero, normalising fetal growth, but is not desirable, especially in the high doses used in this condition, if the fetus is unaffected. Prospective studies of pregnancy in monogenic diabetes are needed.

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“…They found that glyburide achieved similar birth weights and delivery outcomes but was associated with an increased risk of macrosomia as well as a positive trend toward neonatal hypoglycemia. Using the same overall cohort comparing glyburide to insulin in women diagnosed with GDM, Jacobson et al 9 also found that women who received glyburide were more likely to experience pre-eclampsia, neonatal hyperbilirubinemia requiring phototherapy and longer length of stay in the neonatal intensive care unit compared to women who were treated with insulin. These findings suggest that perhaps glyburide may not be equally efficacious as insulin for the management of GDM requiring medical therapy.…”

mentioning

confidence: 97%

Gestational diabetes mellitus: what is the optimal treatment modality?

Cheng

Caughey

2007

J Perinatol

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Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization

Cited by 172 publications

References 11 publications

Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia

Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia

Management of sulfonylurea‐treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer

Gestational diabetes mellitus: what is the optimal treatment modality?

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