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Short-term Outcomes Worse with Glyburide for GDM

Glyburide (glibenclamide) should not be used to treat gestational diabetes mellitus (GDM) unless insulin and metformin are unavailable, the authors of a new systematic review and meta-analysis conclude…

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To compare the risks and benefits of the three treatments, Dr. Rosa Corcoy of the Hospital de la Santa Creu in Barcelona, Spain, one of the study’s authors and her team reviewed 15 randomized controlled trials, including seven comparing glyburide with insulin (798 patients), six comparing metformin to insulin (1,362 patients) and two comparing metformin and glyburide (349 patients).

Babies born to mothers on glyburide weighed more (pooled mean difference 109 grams) than babies whose mothers received insulin treatment. They were also 2.62 times more likely to have macrosomia, and twice as likely to have neonatal hypoglycemia.

When compared to insulin, metformin was associated with significantly less maternal weight gain (pooled mean difference, 1.14 kg), lower age at delivery (pooled mean difference, 0.16 weeks), and a 1.5-fold greater risk of preterm birth. Two studies addressed patient satisfaction, and in both, patients preferred metformin.

In the head-to-head comparisons of metformin and glyburide, maternal weight gain was 2.06 kg lower with metformin; birth weight was 209 grams lower; macrosomia risk was 67% lower, and risk that babies would be born large for gestational age was 56% lower.
Dr. Corcoy and her colleagues note that a large U.S. study found glyburide use jumped from 7.4% in 2000 to 64.5% in 2011 among patients treated for GDM, and that glyburide has been the most common treatment since 2007.

The authors concluded, "At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available."

Practice Pearls:

  • Glyburide (glibenclamide) should not be used to treat gestational diabetes mellitus (GDM) unless insulin and metformin are unavailable.
  • Babies born to mothers on glyburide weighed more (pooled mean difference 109 grams), than those born to mothers on insulin.
  • In the head-to-head comparisons of metformin and glyburide, maternal weight gain was 2.06 kg lower with metformin and macrosomia risk was 67% lower, and risk that babies would be born large for gestational age was 56% lower.

Montserrat Balsells. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis, BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h102 Pub 21 January 2015.