Metformin Versus Glyburide in the Management of Gestational Diabetes; A Systematic Review and Meta-Analysis

Abstract

Background: Globally gestational diabetes remains one most common medical problem facing a significant proportion of women in pregnancy. Understanding safe therapeutic and management measures is imperative to inform effective and sound decision and judgment for clinicians and concerned groups. Aim: This review aimed to compare the effectiveness and safety of Metformin versus Glyburide in managing gestational diabetes mellitus (GDM). Methods: Cochrane Library, PUBMED, MEDLINE and LILACs were subjected to literature search for randomized controlled trials addressing the primary aim of this study. The Key used for the search strategy was: “Metformin”, “Glyburide”, ‘Gestational Diabetes” and other varying terms from Medical subject Headings. The review systematized a PRISMA Checklist and demonstrated Meta analyzed studies mathematically on weight gain after using glyburide and metformin during and after pregnancy, fasting blood glucose, birthweight and postprandial blood glucose. Results: Neonatal hypoglycaemia, mode of delivery, birth weight, Apgar score, weight during and after pregnancy, postprandial blood glucose and requirement for intensive care were all assessed in the study. In 60% of the studies safety and efficacy of glyburide and metformin diabetes management showed no significant difference. From postprandial blood glucose (P=0.217), birth weight (p=0.194), and fasting blood glucose (p=0.821) revealed no statistical differences between the medications in the meta analysis conducted. However, on the other hand, weight growth during pregnancy among patients revealed significant variations (p=0.036). Conclusion: Both metformin and glyburide showed no differences in safety and efficacy considering birth weight, fasting blood glucose and postprandial blood glucose. However, in babies of women treated with metformin, problems associated with neonates such as respiratory issues and hypoglycemia and also increase in weight during pregnancy or gestation are more less common and lower. Keywords: Diabetes, Therapy, Metformin, Glyburide, Gestational Diabetes Mellitus