Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis

Dhulkotia, Jaya Saxena; Ola, Bolarinde; Fraser, Robert; Farrell, Tom

doi:10.1016/j.ajog.2010.06.044

Cited by 125 publications

(89 citation statements)

References 21 publications

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“…Figure 3(a) indicates SMD = 0.13 in favour of glyburideoverinsulin in the control of blood glucose. These findings compare favourably with previous studies thatcompared glyburide and insulin therapy in management of GDM [4] [5]. Langer, Conway, Berkus et al [5] went further, explaining that glyburide reduces hyperglycaemia by increasing peripheral glucose utilisation, decreasing hepatic gluconeogenesis and increasing insulin sensitivity through an increase in intracellular calcium in the beta cell and concurrently stimulating insulin productivity [5].…”

Section: Discussionsupporting

confidence: 83%

“…There is a wide range of therapeutic measures to control GDM, including dietary changes and physical activities either alone or in combination, but insulin therapy remains the technique of choice after diet and physical exercise [4]- [6]. A majority of women who use diet and physical activities incorporate either insulin or oral hypoglycaemic agents in their treatment plan [4] [5].…”

Section: Introductionmentioning

confidence: 99%

“…A majority of women who use diet and physical activities incorporate either insulin or oral hypoglycaemic agents in their treatment plan [4] [5]. However, the disadvantages of insulin use-such as multiple daily injection sites, maternal weight gain, risk of hypoglycaemia, cost of drugs, handling and storage, and the modifications to drug administration based on body mass index, glucose level and lifestyle [6]-have led to the consideration of sulfonylurea (oral hypoglycaemic agents) as a preferred alternative [6].…”

Section: Introductionmentioning

confidence: 99%

“…The formerly traditional use of sulfonylurea drugs in pregnancy has now been discouraged due to the risks of fetal teratogenicity and neonatal hypoglycaemia as a result of its 10% -16% maternal-to-fetal transfer rate [4] [5]. By contrast, glyburide has been found to have low risk of infant growth and teratogenicity, minimal in vitro foetal transfer rate, and safer in vivo fetal-to-maternal transfer rate at a dose of up to 20 mg per day [4].…”

Section: Introductionmentioning

confidence: 99%

“…By contrast, glyburide has been found to have low risk of infant growth and teratogenicity, minimal in vitro foetal transfer rate, and safer in vivo fetal-to-maternal transfer rate at a dose of up to 20 mg per day [4]. Furthermore, it is an inexpensive oral medication compared to insulin [7] and requires no special storage condition nor special training to administer.…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review

Odiba¹,

Mabhala²

2015

JDM

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Background: Insulin therapy has been the mainstay in managing women with gestational diabetes mellitus (GDM), but some disadvantages of insulin have led to the use of glyburide, which is inexpensive in some countries, to manage GDM. However, there has been debate over its effectiveness, efficacy and safety when compared to insulin for maternal glycaemic control, and some adverse neonatal outcomes in GDM. Method: A systematic review of eight randomised controlled trial (RCT) studies was undertaken to compare glyburide and insulin. Studies involving 849 participants were included in the quantitative analysis. Results: There was no significant difference between glyburide and insulin in maternal fasting (P = 0.09; SMD: 0.13; 95% CI: −0.02 to 0.28) and postprandial (P = 0.45; SMD: 0.05; 95% CI: −0.09 to 0.19) glycaemic control and glycosylated haemoglobin (P = 0.35; SMD: 0.08; 95% CI: −0.08 to 0.24). When compared with insulin, glyburide had an increase risk ratio (RR) for neonatal hypoglycaemia (P = 0.0002; RR: 2.27; 95% CI: 1.47 to 3.51) and large for gestational age babies (P = 0.03; RR: 1.60; 95% CI: 1.06 to 2.41). Estimation of standard mean difference shows that neonatal birth weight was significantly higher in subjects receiving glyburide than in the insulin group (P = 0.002; SMD: 0.21; 95% CI: 0.08 to 0.35). Conclusions: Glyburide was seen to be clinically effective and a safer alternative to insulin for maternal glycaemic control in GDM women. It is affordable, convenient and requires no comprehensive educative training at the time of initiation of therapy. However, its adverse outcomes-neonatal hypoglycaemia, high neonatal birth weight and large for gestational age babies-call for careful monitoring of GDM patients for any need for supplemental insulin.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review

Odiba¹,

Mabhala²

2015

JDM

View full text Add to dashboard Cite

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Diabetes in Pregnancy

Ali

Dornhorst

2018

Dewhurst's Textbook of Obstetrics &Amp; Gynaecology

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Metformin in the first trimester and risks for specific birth defects in the National Birth Defects Prevention Study

Dukhovny

Bennekom

Gagnon

et al. 2018

Birth Defects Research

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While metformin use for diabetes was associated with an increased risk of many birth defects, when metformin was used for subfertility most defects had aORs that approximated the null, while only three defects had modestly increased aORs, two of which had lower confidence bounds that included the null. Our study does not suggest that metformin poses an appreciable risk for major birth defects, but further studies are necessary.

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Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis

Cited by 125 publications

References 21 publications

The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review

The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review

Diabetes in Pregnancy

Metformin in the first trimester and risks for specific birth defects in the National Birth Defects Prevention Study

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