Trends in Glyburide Compared With Insulin Use for Gestational Diabetes Treatment in the United States, 2000–2011

Abstract

Objective To describe trends and identify factors associated with choice of pharmacotherapy for gestational diabetes (GDM) from 2000–2011 using a healthcare claims database. Methods This was a retrospective cohort study of a large nationwide population of commercially insured women with GDM and pharmacy claims for glyburide or insulin prior to delivery, 2000–2011. We excluded women younger than 15 years or older than 50 years, those with prior type 2 diabetes, or those who had multiple gestations. We estimated trends over time in the use of glyburide compared with insulin and prevalence ratios (PR) and 95% confidence intervals (CI) for the association between covariates of interest and treatment with glyburide compared with insulin. Results We identified 10,778 women with GDM treated with glyburide (n=5,873) or insulin (n=4,905). From 2000–2011, glyburide use increased from 7.4% to 64.5%, becoming the more common treatment in 2007. Women less likely to be treated with glyburide were those with metabolic syndrome (PR=0.71, 95%CI: 0.50– 0.99), hyperandrogenism (PR=0.77, 95%CI: 0.62–0.97), polycystic ovarian syndrome (PR=0.88, 95%CI: 0.78–0.99), hypothyroidism (PR=0.89, 95%CI: 0.83–0.96) or undergoing infertility treatment (PR=0.93, 95%CI: 0.86–1.02). The probability of receiving glyburide decreased by 5% for every 10-year increase in maternal age (PR=0.95, 95%CI: 0.91–0.99). Among women prescribed with glyburide, 7.8% switched or augmented to a different drug class compared with 1.1% of insulin initiators. Conclusion Glyburide has replaced insulin as the more common pharmacotherapy for GDM over the last decade among those privately insured. Given its rapid uptake and the potential implications of suboptimal glucose control on maternal and neonatal health, robust evaluation of glyburide’s relative effectiveness is warranted to inform treatment decisions for women with gestational diabetes.

Prevalence of Gestational Diabetes Mellitus in Korea: A National Health Insurance Database Study

“…With the changing prevalence of GDM, trends in prescription of glucose-lowering agents for patients with GDM have also changed. A retrospective cohort study of the nationwide population in the U.S., performed in 2000–2011, showed that glyburide replaced insulin as the most common pharmacotherapy for GDM [ 5 ], and glyburide use increased from 7.4% to 64.5% over the past decade [ 5 ].…”

Antidiabetic medication use during pregnancy: an international utilization study

“…US guidelines still maintain that insulin is the only safe choice for pharmaceutical treatment of diabetes in pregnancy, but the American Diabetes Association recommendations state that metformin and glibenclamide can be used with the caveat of there being no longer term follow-up on the children exposed to these medications in pregnancy (G12 and G14). A previous study in the US MarketScan database showed that glibenclamide use increased from 2000 to 2011 to replace insulin as the most common GDM treatment from 2007 onward 31. Our study includes US MarketScan data from 2012 to 2015 and shows that glibenclamide continues to be the most commonly used ADM for GDM treatment, and overall, metformin is the most commonly used ADM in this population of privately insured pregnant women.…”

Identification of CYP3A7 for glyburide metabolism in human fetal livers

“…Glyburide is an oral hypoglycemic drug that is prescribed more commonly for the treatment of GDM than before [3]. Though glyburide exhibits nearly comparable efficacy to insulin, the incidence rates of adverse fetal effects associated with glyburide verses insulin therapy, such as neonatal hypoglycemia and large for gestational age infants, are conflicting [4–8].…”