Comparative Efficacy and Safety of OADs in Management of GDM: Network Meta-analysis of Randomized Controlled Trials

Abstract

Both metformin and glyburide are suitable for use in the management of gestational diabetes because of good glycemic control. However, glyburide treatment is associated with increased risk of neonatal hypoglycemia, high maternal weight gain, high neonatal birth weight, and macrosomia.

Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study

“…The efficacy of glyburide as an oral agent in GDM was questioned because glyburide was inferior to both insulin and metformin. Glyburide was inferior to insulin because of an elevated risk for neonatal intensive care unit admission, respiratory distress, neonatal hypoglycemia, birth injury, increased birth weight, large-forgestational-age neonate, and macrosomia (3,13,14,19). Compared with metformin, glyburide was associated with a lower fasting blood glucose during treatment but a higher maternal weight gain, birth weight, macrosomia, large-for-gestational-age newborn, and neonatal hypoglycemia (3,12).…”

“…Thus, glyburide might lead to fetal overgrowth and neonatal hypoglycemia through excessive fetal insulin secretion, whereas metformin increases insulin sensitivity in the target organs without causing hyperinsulinism (2). The favorable effects of metformin should be balanced with a possible increase of preterm births after metformin treatment compared with insulin (2,3,14) but not glyburide (3).…”

“…Second, studies comparing the efficacy and safety of glyburide versus metformin have conflicting results regarding the best medication to use as a first-line therapy (10)(11)(12). Finally, in studies evaluating oral hypoglycemic medications for GDM, in case of a treatment failure, the second-line treatment was always insulin (1)(2)(3)(8)(9)(10)(11)(12)(13)(14).…”

Efficacy and safety of metformin for the treatment of gestational diabetes: a new approach to the problem

“…Поэтому существует ряд ис-следований, где сравнивались не только метформин с инсулином, но и препараты сульфонилмочевины (глибенкламид/глибурид). Метаанализы по результатам проведенных РКИ по сравнению инсулинотерапии при ГСД с пероральными сахароснижающими препаратами в целом (метформин/инсулин, глибенкламид/инсулин и/или глибенкламид/метформин) показали, что метфор-мин является лучшей альтернативой инсулинотерапии в плане эффективности и безопасности [29][30][31][32][33][34][35]. По срав-нению с препаратами сульфонилмочевины, метформин реже приводит к неонатальной гипогликемии, при этом имеется тенденция к более низкому риску гипертензив-ных расстройств при беременности и меньшему набору массы тела.…”

12. Management of Diabetes in Pregnancy

“…Metformin, which is associated with a lower risk of hypoglycemia and potential lower weight gain, may be preferable to insulin for maternal health if it suffices to control hyperglycemia (23)(24)(25); however, metformin may slightly increase the risk of prematurity. None of these studies or meta-analyses evaluated long-term outcomes in the offspring.…”