Use of antidiabetic agents in the treatment of gestational diabetes mellitus in Germany, 2008–2012

Abstract

Aim: Adequate blood glucose control during pregnancy is important because gestational diabetes mellitus (GDM) is known to have adverse effects on the mother and child. Due to an increasing prevalence of GDM in recent years, more information on the use of different antidiabetic agents is required, which was the aim of the present study. Material and Methods: Data from 32 diabetic practices in Germany were collected from January 2008 to December 2012 and analyzed using the Disease Analyzer Database. All women with International Classification of Diseases diagnosis O24 (that is, GDM) participated, except for patients with known type I or II diabetes mellitus, who were excluded. Analysis focused on the proportion of women requiring drug treatment in general. Thereafter, subanalysis was performed with a focus on the administration of different antidiabetic agents, namely insulin, metformin, and sulfonylurea. Results: Within the given timeframe, medication-based treatment for GDM significantly rose to reach 30.8% of all women with GDM. Both the administration of insulin and metformin grew considerably within the 5-year period with metformin being increasingly used without supplemental insulin and at lower dosages. Within the insulin treatment arm, insulin analogues became increasingly important. The proportion of sulfonylurea remained stable (0.2%). Conclusions: GDM is more often treated with antidiabetic agents and, due to the fact that metformin is more frequently prescribed, it can be assumed that it is increasingly regarded as a safe and effective alternative to insulin.

Patterns of glucose‐lowering therapies and neonatal outcomes in the treatment of gestational diabetes in Canada, 2009–2014

“…The pharmacological treatment rates in the present study were very similar to those reported in a German study that also looked at the distribution of glucose-lowering therapy use among women with GDM between 2008 and 2012 [15]. The authors of that study similarly observed significant increases over time in the proportion of women treated with any type of glucose-lowering therapy, the proportion who received metformin, and the proportion who were treated with insulin [15]. Sulfonylurea use was minimal in both studies, being used by only 0.07% of women with GDM in the present study and 0.2% in the German study.…”

“…LGA rates were significantly higher in pregnancies receiving pharmacological treatment than in those that did not receive any pharmacological treatment, but did not differ significantly between those treated with insulin only or with metformin (+/-insulin). The pharmacological treatment rates in the present study were very similar to those reported in a German study that also looked at the distribution of glucose-lowering therapy use among women with GDM between 2008 and 2012 [15]. The authors of that study similarly observed significant increases over time in the proportion of women treated with any type of glucose-lowering therapy, the proportion who received metformin, and the proportion who were treated with insulin [15].…”

“…It provides evidence, corroborating the findings of a German study [15], that women with GDM are increasingly being treated with some type of glucose-lowering therapy, and in particular, treatment with metformin or insulin is becoming more prevalent. The present study included a large, contemporary, population-based cohort of >16 500 women with GDM, which was much larger than that of the German study, which included >6500 women with GDM [15]. We also had information on a number of demographic, maternal and neonatal variables.…”

“…There is currently limited evidence on the pattern of use of various glucose‐lowering agents in treating GDM . The aim of the present study was to examine the use of different glucose‐lowering agents for treating GDM in a large, population‐based cohort of women with universal health coverage in Alberta, Canada.…”

A comparative study of metformin and glyburide in gestational diabetes mellitus

“…11,12 In a large nationwide retrospective cohort study in the United States including 10,778 women with drug treated gestational diabetes, use of glibenclamide (glyburide) increased from 7.4% in 2000 to 64.5% in 2011, superseding insulin as most common treatment since 2007. 11 In spite of all these studies answer of the question which oral hypoglycaemic should be used for gestational diabetes?…”