A comparative study of metformin and glyburide in gestational diabetes mellitus

Abstract

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.

Metformin for prevention of hypertensive disorders of pregnancy in women with gestational diabetes or obesity: systematic review and meta‐analysis of randomized trials

“…The participants' characteristics varied among the studies, which included women with GDM (13 studies) or obese women (two studies). Metformin was compared with insulin (eight studies), placebo (two studies) or glyburide (five studies) 10,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] . Mean gestational age at randomization and the risk characteristics differed greatly among the studies (Table 1).…”

“…BMI, body mass index; GA, gestational age; GDM, gestational diabetes mellitus; NR, not reported. 31 15 (31.9) 750-2250 NR NR Moore (2010) 27 26 (34.7) 500-2000 NR NR Nachum (2017) 26 9 (17) 850-2250 NR NR Najafian (2017) 38 NR 500-2000 NR 26% of patients were on 2000 mg, 66% were on 1500 mg, 5.9% were on 1000 mg and 1% were on 500 mg Niromanesh (2012) 32 11 (13.8) 1000-2500 NR Median, 1500 mg (IQR: 1000-2500 mg) Pujara (2017) 37 13 (26.0) 500-2500 NR NR Rowan (2008) 33 168 (46.3) 500-2500 69.4% All but one participant received more than 1000 mg, with median dose of 2500 mg Saleh (2016) 39 NR 500-3000 NR NR Silva (2010) 34 8 (25.0) 500-2500 NR Mean ± SD, 1284 ± 535 mg Spaulonci (2013) 35 12 ( First author only is given for each study. *Reported as per individual study protocol.…”

“…We used both random-and fixed-effects models for studies comparing metformin with placebo, which yielded conflicting results. The studies included in this analysis were quite similar in their design and execution, and thus were characterized by low clinical Moore (2010) 27 Nachum (2017) 26 Pujara (2017) 37 Silva (2010) 34 Ainuddin (2014) 28 Ijas (2011) 31 Najafian (2017) 38 Niromanesh (2012) 32 Rowan (2008) 33 Saleh (2016) 39 Spaulonci (2013) 35 Tertti (2013) 36 Chiswick (2015) 29 Syngelaki (2016) Silva (2010) 34 Ainuddin (2014) 28 Niromanesh (2012) 32 Rowan (2008) 33 Tertti (2013) 36 Chiswick (2015) 29 Syngelaki (2016) 10 Summary estimate Moore (2010) 27 Ainuddin (2014) 28 Ijas (2011) 31 Najafian (2017) 38 Niromanesh (2012) 32 Rowan (2008) 33 Saleh (2016) 39 Spaulonci (2013) 35 Tertti (2013) 36 Chiswick (2015) 29 Syngelaki (2016) heterogeneity but high statistical heterogeneity. However, it is unlikely that the summary estimates presented by either method are good representations of the real effect.…”

Role of metformin and glibenclamidein controlling gestational diabetes mellitus

“…As failure of glycemic control was 26% with metformin and 2% with glibenclamide use as shown in the study of Pujara et al, 2017 [8] , so with power 80% and confidence level 95% sample size will be 64 distributed between two groups and with 20% non-responder rate it will be 80 (40 in each group).…”

“…Long-term safety data about oral drugs are lacking [7] . Insulin therapy requires special handling, storage, frequent monitoring, given in as multiple subcutaneous injections and expensive; thus it is not suitable for low income countries especiallyin ignorant and poor patients [8] .…”