Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization

Abstract

ObjectiveTo compare the use of glyburide to insulin for treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy.Study designA protocol for treating GDM with glyburide was adopted in Kaiser Permanente Northern California in 2001. We identified women with singleton pregnancies diagnosed with GDM between 12 and 34 weeks who failed diet therapy from 1999-02. We compared women treated with insulin in 1999-00 to women treated with glyburide in 2001-02. Primary outcomes were birth weight and glycemic control. Secondary outcomes were maternal and neonatal complications. Statistical methods included Student's t-test, Chi square and logistic regression analysis (in process).ResultsWe identified 584 women: 268 diagnosed in 1999-00 and treated with insulin; 316 diagnosed in 2001-02 of which 236 (75%) received glyburide. The two groups were similar except women in the insulin group had: higher mean BMI (31.9 ± 6.8, 30.6 ± 7.0, P = .04), greater proportion self-identified as white (43%, 28%, P < .001) and fewer as Asian (24%, 37%, P = .001), higher mean fasting on GTT (105.4 ± 12.9, 102.4 ± 14.2, P = .01), higher pre-treatment fasting (107 ± 14, 99 ± 13, P < .001) and 1 hr post-prandial plasma glucose values (143 ± 27, 140 ± 26, P = .008). There were no significant differences in mode of delivery, birth weight, LGA, hyperbilirubinemia, neonatal hypoglycemia, polycythemia, congenital anomalies, birth injuries, or need for assisted ventilation. Women in the glyburide group had lower post-treatment fasting (90 ± 13, 97 ± 12, P < .001) and 1 hr post-prandial glucose values (131 ± 23, 137 ± 24, P < .001), and a higher incidence of preeclampsia (12%, 6%, P = .02). Neonates in the glyburide group were more likely to receive phototherapy (9%, 5%, P = .046) and less likely to be admitted to the NICU (15%, 24%, P = .008).ConclusionIn a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study. ObjectiveTo compare the use of glyburide to insulin for treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy. To compare the use of glyburide to insulin for treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy. Study designA protocol for treating GDM with glyburide was adopted in Kaiser Permanente Northern California in 2001. We identified women with singleton pregnancies diagnosed with GDM between 12 and 34 weeks who failed diet therapy from 1999-02. We compared women treated with insulin in 1999-00 to women treated with glyburide in 2001-02. Primary outcomes were birth weight and glycemic control. Secondary outcomes were maternal and neonatal complications. Statistical methods included Student's t-test, Chi square and logistic regression analysis (in process). A protocol for treating GDM with glyburide was adopted in Kaiser Permanente Northern California in 2001. We identified women with singleton pregnancies diagnosed with GDM between 12 and 34 weeks who failed diet therapy from 1999-02. We compared women treated with insulin in 1999-00 to women treated with glyburide in 2001-02. Primary outcomes were birth weight and glycemic control. Secondary outcomes were maternal and neonatal complications. Statistical methods included Student's t-test, Chi square and logistic regression analysis (in process). ResultsWe identified 584 women: 268 diagnosed in 1999-00 and treated with insulin; 316 diagnosed in 2001-02 of which 236 (75%) received glyburide. The two groups were similar except women in the insulin group had: higher mean BMI (31.9 ± 6.8, 30.6 ± 7.0, P = .04), greater proportion self-identified as white (43%, 28%, P < .001) and fewer as Asian (24%, 37%, P = .001), higher mean fasting on GTT (105.4 ± 12.9, 102.4 ± 14.2, P = .01), higher pre-treatment fasting (107 ± 14, 99 ± 13, P < .001) and 1 hr post-prandial plasma glucose values (143 ± 27, 140 ± 26, P = .008). There were no significant differences in mode of delivery, birth weight, LGA, hyperbilirubinemia, neonatal hypoglycemia, polycythemia, congenital anomalies, birth injuries, or need for assisted ventilation. Women in the glyburide group had lower post-treatment fasting (90 ± 13, 97 ± 12, P < .001) and 1 hr post-prandial glucose values (131 ± 23, 137 ± 24, P < .001), and a higher incidence of preeclampsia (12%, 6%, P = .02). Neonates in the glyburide group were more likely to receive phototherapy (9%, 5%, P = .046) and less likely to be admitted to the NICU (15%, 24%, P = .008). We identified 584 women: 268 diagnosed in 1999-00 and treated with insulin; 316 diagnosed in 2001-02 of which 236 (75%) received glyburide. The two groups were similar except women in the insulin group had: higher mean BMI (31.9 ± 6.8, 30.6 ± 7.0, P = .04), greater proportion self-identified as white (43%, 28%, P < .001) and fewer as Asian (24%, 37%, P = .001), higher mean fasting on GTT (105.4 ± 12.9, 102.4 ± 14.2, P = .01), higher pre-treatment fasting (107 ± 14, 99 ± 13, P < .001) and 1 hr post-prandial plasma glucose values (143 ± 27, 140 ± 26, P = .008). There were no significant differences in mode of delivery, birth weight, LGA, hyperbilirubinemia, neonatal hypoglycemia, polycythemia, congenital anomalies, birth injuries, or need for assisted ventilation. Women in the glyburide group had lower post-treatment fasting (90 ± 13, 97 ± 12, P < .001) and 1 hr post-prandial glucose values (131 ± 23, 137 ± 24, P < .001), and a higher incidence of preeclampsia (12%, 6%, P = .02). Neonates in the glyburide group were more likely to receive phototherapy (9%, 5%, P = .046) and less likely to be admitted to the NICU (15%, 24%, P = .008). ConclusionIn a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study. In a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study.