Metformin Compared With Glyburide in Gestational Diabetes

Moore, Lisa E.; Clokey, Diana; Rappaport, Valerie J.; Curet, Luis B.

doi:10.1097/aog.0b013e3181c52132

Cited by 154 publications

(160 citation statements)

References 11 publications

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“…They found failure rate of metformin (34.7%) 2.1 times higher than glyburide (16.2%). 17 Failure rate of glyburide in this study (16.2%) is significantly higher than the 4% failure rate reported in the initial study by Langer et al, failure rate of metformin in this study (34.7%) is in line with the study reported by Rowan et al in which 46.3% of patientsreceiving metformin received supplemental insulin to achieve euglycemia. 19,20 Among maternal variables glycemic control of both groups were comparable.…”

supporting

confidence: 71%

“…Studies were performed in the Mexico and Brazil, and diagnostic criteria were those of Carpenter and Coustan and the WHO respectively. 17,18 We undertook this study in order to determine the effects of glyburide and metformin in the Indian pregnant womendiagnosed to have gestational diabetes mellitus according to DIPSI criteria and to compare each other.…”

Section: Introductionmentioning

confidence: 99%

“…17,18 In 2010, Moore et al compared efficacy of metformin and glyburide in the management of GDM. They found failure rate of metformin (34.7%) 2.1 times higher than glyburide (16.2%).…”

mentioning

confidence: 99%

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A comparative study of metformin and glyburide in gestational diabetes mellitus

Pujara

Singh

Murmu

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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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.

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supporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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A comparative study of metformin and glyburide in gestational diabetes mellitus

Pujara

Singh

Murmu

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…First, although the success rate in a pioneer study was 96% for patients not requiring insulin (1), later studies have not demonstrated the same efficacy, with 20-25% and 45% of the patients taking glyburide and metformin, respectively, requiring second-line therapy with insulin because of poor glycemic control or adverse effects (2,9). Second, studies comparing the efficacy and safety of glyburide versus metformin have conflicting results regarding the best medication to use as a first-line therapy (10)(11)(12). Finally, in studies evaluating oral hypoglycemic medications for GDM, in case of a treatment failure, the second-line treatment was always insulin (1)(2)(3)(8)(9)(10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

“…Second, studies comparing the efficacy and safety of glyburide versus metformin have conflicting results regarding the best medication to use as a first-line therapy (10)(11)(12). Finally, in studies evaluating oral hypoglycemic medications for GDM, in case of a treatment failure, the second-line treatment was always insulin (1)(2)(3)(8)(9)(10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

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

et al. 2017

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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.

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