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

Lanlan Guo,Jia Tang,Wei Zhang,Xue Zhao,Dingyao Hu,Jing Ma

doi:10.1155/2019/9804708

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.

Highlights

Gestational diabetes mellitus (GDM) is the most frequent medical complication of pregnancy and becoming a major global public health issue with the increasing prevalence in recent years due to the epidemic of obesity and type 2 diabetes
In the pairwise meta-analysis, we observed that metformin was associated with a significantly reduced incidence of induction of labor compared with insulin (RR, 0.85; 95% confidence intervals (CI), 0.74 to 0.99; P < 0:05)
To the outcomes of neonatal blood glucose and birth weight, metformin had a lower increase when compared with insulin (MD, 2.95; 95% CI, 0.63 to 5.26; P < 0:05; mean difference (MD), 114.48; 95% CI, 37.32 to 191.64; P < 0:01; respectively)

Summary

Introduction

Gestational diabetes mellitus (GDM) is the most frequent medical complication of pregnancy and becoming a major global public health issue with the increasing prevalence in recent years due to the epidemic of obesity and type 2 diabetes. GDM affects about 7% of pregnancies in North America and has a global prevalence range from 5.8% to 12.9% and is associated with several maternal and neonatal adverse outcomes [1]. Treatment of GDM can prevent short-term maternal and neonatal complications. Almost 30% of women with GDM cannot be managed with diet and lifestyle modification alone and require pharmacological therapy to reduce the associated maternal and neonatal short- and long-term effects of GDM [6, 7]

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