Treatment of gestational diabetes mellitus: glyburide compared to subcutaneous insulin therapy and associated perinatal outcomes

Abstract

Objective To examine perinatal outcomes in women with gestational diabetes mellitus treated with glyburide compared to insulin injections. Study design This is a retrospective cohort study of women diagnosed with gestational diabetes mellitus (GDM) who required pharmaceutical therapy and were enrolled in the Sweet Success California Diabetes and Pregnancy Program between 2001 and 2004, a California state-wide program. Women managed with glyburide were compared to women treated with insulin injections. Perinatal outcomes were compared using chi-square test and multivariable logistic regression models; statistical significance was indicated by p < 0.05 and 95% confidence intervals (CI). Results Among the 10,682 women with GDM who required medical therapy and met study criteria, 2073 (19.4%) received glyburide and 8609 (80.6%) received subcutaneous insulin injections. Compared to insulin therapy and controlling for confounders, oral hypoglycemic treatment was associated with increased risk of birthweight >4000 g (aOR = 1.29; 95% CI [1.03–1.64]), and admission to the intensive care nursery (aOR = 1.46 [1.07–2.00]). Conclusion Neonates born to women with gestational diabetes managed on glyburide, and were more likely to be macrosomic and to be admitted to the intensive care unit compared to those treated with insulin injections. These findings should be examined in a large, prospective trial.

The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review

“…These findings can be compared with a retrospective cohort study conducted by Cheng et al [20] which also indicated a greater likelihood of higher birth weight of infants above 4000 g for GDM mothers treated with glyburide compared to insulin treatments.…”

“…Several studies [4] [20] found that there is a 2.27 times greater likelihood of neonatal hypoglycaemia in mothers treated with glyburide compare to insulin treatments. In addition there are other reported side effects such as respiratory distress, jaundice, skin allergy, anaphylactic reactions, elevated liver enzymes, haematological disorder and low visual acuity due to imbalanced glycaemic level [20]. The retrospective cohort study conducted by Cheng et al [20] revealed that neonates born to mothers treated with glyburide have a greater propensity to be admitted to NICU compared to those managed using insulin.…”

The Effect of Maternal Obesity on Pregnancy Outcomes of Women with Gestational Diabetes Controlled with Diet Only, Glyburide, or Insulin

“…Dissimilar to our current results showing no difference in rates of birth weight >4000 g or neonatal intensive care unit admission between glyburide versus insulin groups, a recent study by Cheng et al reported that infants born to women treated with glyburide (n ¼ 2073) were at increased risk of birth weight >4000 g and more likely to be admitted to the intensive care nursery than those women managed with insulin (n ¼ 8609). 13 The Dhulkotia et al meta-analysis also examined the safety of OHA in pregnancy. 8 In vitro studies have shown minimal transfer, and an in vivo study has shown transfer but mentions that glyburide appears safe to the fetus at maternal doses up to 20 mg/d.…”

Gestational diabetes: screening for all, which test and which treatment?

“…Finally, recent data on a large retrospective cohort from California, USA, of 10,000 women with GDM, of whom 2000 were treated with glyburide, was presented. The use of glyburide was associated with a significantly higher incidence of birth weight >4000 g (odds ratio: 1.29) and a significantly higher incidence of admission to the neonatal intensive care unit (odds ratio: 1.46) [11]. The US FDA has categorized glyburide as class C and most discussants at the meeting thought it should stay in that category.…”