Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study

Abstract

OBJECTIVETo compare the efficacy and safety of glyburide versus metformin and their combination for the treatment of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODSIn this prospective randomized controlled study, we randomly assigned patients with GDM at 13-33 weeks gestation and whose blood glucose was poorly controlled by diet to receive either glyburide or metformin. If optimal glycemic control was not achieved, the other drug was added. If adverse effects occurred, the drug was replaced. If both failed, insulin was given. The primary outcomes were the rate of treatment failure and glycemic control after the first-line medication according to mean daily glucose charts. RESULTSGlyburide was started in 53 patients and metformin in 51. In the glyburide group, the drug failed in 18 (34%) patients due to adverse effects (hypoglycemia) in 6 (11%) and lack of glycemic control in 12 (23%). In the metformin group, the drug failed in 15 (29%) patients, due to adverse effects (gastrointestinal) in 1 (2%) and lack of glycemic control in 14 (28%). Treatment success after second-line therapy was higher in the metformin group than in the glyburide group (13 of 15 [87%] vs. 9 of 18 [50%], respectively; P = 0.03). In the glyburide group, nine (17%) patients were eventually treated with insulin compared with two (4%) in the metformin group (P = 0.03). The combination of the drugs reduced the need for insulin from 33 (32%) to 11 (11%) patients (P = 0.0002). Mean daily blood glucose and other obstetrical and neonatal outcomes were comparable between groups, including macrosomia, neonatal hypoglycemia, and electrolyte imbalance. CONCLUSIONSGlyburide and metformin are comparable oral treatments for GDM regarding glucose control and adverse effects. Their combination demonstrates a high efficacy rate with a significantly reduced need for insulin, with a possible advantage for metformin over glyburide as first-line therapy.

A Concept Map of Neonatal Hypoglycemia

“…The wording of questionnaire items was guided by keywords selected on the basis of the recent literature on the topic. Multiple-choice questions were also based on the literature [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

Comment on Nachum et al. Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study. Diabetes Care 2017;40:332–337

“…Given the increasing popularity of oral agents, we commend Nachum et al (1) on their randomized controlled trial examining metformin or glyburide as a first-line agent to treat gestational diabetes mellitus (GDM) and adding or switching to the alternate agent for adverse events or failures. However, we question whether the study design and conclusions can be generalized to many GDM populations.…”

The diversity of gestational diabetes: a therapeutic challenge

“…A recent comparison with metformin in GDM pregnancies was slightly in favor of metformin 5 , in metaanalysis however, the risk of neonatal hypoglycemia and macrosomia remains increased 1 , whereas other perinatal outcomes are similar to other medications.…”