Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis

Balsells, Montserrat; García‐Patterson, Apolonia; Solà, Iván; Figuls, Marta Roqué i; Gich, Ignasi; Corcoy, Rosa

doi:10.1136/bmj.h102

Cited by 383 publications

(381 citation statements)

References 34 publications

Supporting

Mentioning

322

Contrasting

Unclassified

Order By: Relevance

“…This metaanalysis included six randomized trials comparing metformin and insulin. 23 Failure rate of glyburide in our study (2.77%) is also comparable to studies comparing glyburide and insulin. The meta-analysis published in 2015, Odiba et al found the average failure rate of glyburide 6.47% when glyburide was used for the management of GDM.…”

supporting

confidence: 86%

“…In another article published in 2015; Odiba et al compared glyburide and insulin for perinatal outcomes and found that treatment of gestational diabetes with glyburide is associated with 1.40 times increased risk of neonatal hypoglycemia and 1.41 times increased risk of having LGA. 23,25 The study was started with null hypothesis. According to that it was presumed that metformin and glyburide are equally effective in achieving glycemic targets without affecting maternal, fetal or neonatal outcomes.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A comparative study of metformin and glyburide in gestational diabetes mellitus

Pujara

Singh

Murmu

et al. 2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

Background: Incidence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM provides a window of opportunity for the primary prevention of the type 2 diabetes by preventing transgeneration transmission to fetus. Insulin in management of GDM has many drawbacks, so use of OHAs has been increased worldwide.Methods: Randomized control trial was performed in patients with GDM who required medical management. Subjects were randomized into two groups and treated with Metformin and Glyburide, results were compared.Results: While comparing efficacy of metformin and glyburide in this study for maternal variables; the failure rate of metformin was found to be 9.39 times higher compared to glyburide. Glyburide was associated with 9.5 times more risk to develop hypoglycemia in mother compared to metformin. While comparing neonatal variables nursery admission was found to be more and statistically significant in neonates whose mother has received glyburide compared to metformin (p=0.03, RR=2.26). Though statistically insignificant, LGA fetuses and neonatal hypoglycemia were 2.1 times more in glyburide group compared to metformin.Conclusions: Though glyburide can be effective alternative to metformin and insulin for GDM, it is associated with higher risk of maternal hypoglycemia, neonatal hypoglycemia, LGA fetuses and higher rate of nursery admissions compared to metformin. Higher adverse neonatal outcomes with glyburide use question the widespread use of glyburide as first line management modality in GDM and also as an alternative to insulin as advised by many groups.

show abstract

supporting

confidence: 86%

mentioning

confidence: 99%

A comparative study of metformin and glyburide in gestational diabetes mellitus

Pujara

Singh

Murmu

et al. 2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

show abstract

“…An additional study in 2073 women also found higher odds of neonatal intensive care admission (adjusted odds ratio 1.46, 95%CI 1.07–2.00) and birth weight >4000 g (adjusted odds ratio 1.29, 95% CI 1.03–1.64) amongst infants born to mothers receiving glibenclamide during pregnancy 27. The evidence now indicates that glibenclamide treatment in the third trimester exacerbates fetal hyperinsulinism in utero and has an additive effect on birth weight 10, 26, 28. These studies have raised concern regarding the use of glibenclamide in pregnancy 25.…”

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

confidence: 99%

“…Even though good glycaemic control may be maintained, pregnant women with GDM treated with glibenclamide had larger babies than insulin‐treated mothers, further increasing the risk of obstetric and neonatal complications from macrosomia 25, 26. In a meta‐analysis of randomized controlled trials, glibenclamide use resulted in greater birth weight (mean difference 109 g; 95% CI 36–181), and higher risks of macrosomia [risk ratio (RR) 2.62, 95% CI 1.35–5.08) and fetal hypoglycaemia (RR 2.04, 95% CI 1.30–3.20) 10. In a large cohort study from the USA in 110 000 women with GDM, newborns of women treated with glibenclamide (glyburide) were at higher risk of neonatal intensive care unit admission (RR 1.41; 95% CI 1.23–1.62), respiratory distress (RR 1.63; 95% CI 1.23–2.15), hypoglycaemia (RR 1.40; 95% CI 1.00–1.95), birth injury (RR 1.35; 95% CI 1.00–1.82), and large for gestational age (RR 1.43, 95% CI 1.16–1.76) compared with those treated with insulin 26.…”

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

confidence: 99%

See 1 more Smart Citation

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract