Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis

Abstract

To compare the efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus (GDM), a meta-analysis of randomized controlled trials (RCTs) was conducted. PubMed, Embase, CINAHL, Web of Science, and Cochrane Library to November 13, 2018, were searched for RCT adjusted estimates of the efficacy and safety of metformin, glyburide, and insulin treatments in GDM patients. There were 41 studies involving 7703 GDM patients which were included in this meta-analysis; 12 primary outcomes and 24 secondary outcomes were detected and analyzed. Compared with metformin, insulin had a significant increase in the risk of preeclampsia (RR, 0.57; 95% CI, 0.45 to 0.72; P<0.001), NICU admission (RR, 0.75; 95% CI, 0.64 to 0.87; P<0.001), neonatal hypoglycemia (RR, 0.57; 95% CI, 0.49 to 0.66; P<0.001), and macrosomia (RR, 0.68; 95% CI, 0.55 to 0.86; P<0.05). To the outcomes of birth weight and gestational age at delivery, insulin had a significant increase when compared with metformin (MD, 114.48; 95% CI, 37.32 to 191.64; P<0.01; MD, 0.23; 95% CI, 0.12 to 0.34; P<0.001; respectively). Of the two groups between glyburide and metformin, metformin had lower gestational weight gain compared with glyburide (MD, 1.67; 95% CI, 0.26 to 3.07; P<0.05). Glyburide had a higher risk of neonatal hypoglycemia compared with insulin (RR, 1.76; 95% CI, 1.32 to 2.36; P<0.001). This meta-analysis found that metformin could be a safe and effective treatment for GDM. However, clinicians should pay attention on the long-term offspring outcomes of the relative data with GDM patients treated with metformin. Compared with insulin, glyburide had a higher increase of neonatal hypoglycemia. The use of glyburide in pregnancy for GDM women appears to be unclear.

Comparison of Fetomaternal Outcomes in Patients With Gestational Diabetes Mellitus Treated With Insulin Versus Acarbose: Results of a Prospective, Open Label, Controlled Study

“…A Cochrane analysis reported no difference between insulin and oral anti-diabetic drugs for the risk of preeclampsia [ 20 ]. According to the results of another meta-analysis, insulin had significantly higher risk of preeclampsia than metformin [ 21 ].…”

“…In another study, there was no difference in newborn weight in mothers with GDM treated with insulin, glyburide and acarbose [ 11 ]. Significant increase in birth weight and gestational age at delivery has been reported with insulin as compared to metformin [ 21 ]. In a meta-analysis of oral antidiabetic drugs and insulin, shortest gestational age at delivery and lowest mean birth weight has been reported with glyburide [ 19 ].…”

“…Metformin is associated with low incidence of macrosomia [ 19 ]. According to the results of a meta-analysis, insulin had significantly higher risk macrosomia than metformin [ 21 ].…”

“…However, in a Cochrane review, there was no evidence of a clear difference between insulin and oral antidiabetic therapy [ 20 ]. In another meta-analysis, glyburide had a higher increase of neonatal hypoglycemia compared to insulin [ 21 ]. According to the results of a meta-analysis, insulin had significantly higher risk of neonatal hypoglycemia than metformin [ 21 ].…”

The 100 Top-Cited Systematic Reviews/Meta-Analyses on Diabetic Research

“…Systematic reviews/meta-analyses use systematic methods to collect secondary data, critically appraise research studies, and synthesize studies [ 11 , 21 – 27 ]. They are designed to provide a complete, exhaustive summary of current evidence relevant to a research question and are the key to the practice of evidence-based medicine and have always been used in practice guideline [ 28 – 30 ].…”