Abstract
ABSTRACTObjective To compare the major outcomes of use of metformin and glyburide in treatment of gestational diabetes mellitus.Methods Studies published in English, in the last 10 years, in the databases MEDLINE®, SciELO, LILACS and Cochrane Library were analyzed, and randomized controlled trials were selected. Health Sciences Descriptors were used to compose the search phrase, and the keywords “Gestational diabetes”, “Glyburide”, “Metformin” and their variations were searched in the Medical Subject Headings. PRISMA systematization was used to prepare this review, and a meta-analysis was conducted aiming to mathematically show the results of fasting blood glucose, postprandial blood glucose, birth weight and weight gain during pregnancy after using metformin and glyburide.Results The studies evaluated birth weight, neonatal hypoglycemia, mode of delivery, need for intensive care, Apgar score, macrosomia, fasting glucose, postprandial glucose and weight gain during pregnancy. In 60% of studies, there were no statistically significant differences regarding safety and efficacy of administration of metformin and glyburide. Meta-analysis demonstrated the absence of statistical differences between these drugs in fasting blood glucose (p=0.821), postprandial blood glucose (p=0.217) and birth weight (p=0.194). However, significant differences were shown in weight gain during pregnancy (p=0.036).Conclusion The methods are effective, but the adverse effects of glyburide are more common; therefore, the use of metformin should be recommended, if in monotherapy.
Highlights
The pregnancy state is already defined as a condition of predisposition to diabetes, due to the production of placental enzymes, and hyperglycemic hormones
This increases their production and tissue resistance, which can evolve to pancreatic cell dysfunction.(1) One of the consequences is gestational diabetes mellitus (GDM), which is a carbohydrate intolerance of variable severity
Such an association may be a desirable approach for women with GDM with glucose levels that remain above the range despite the maximum tolerated by oral monotherapy.(8) This treatment has the potential to avoid discomfort of subcutaneous injections and the high costs of insulin therapy, as well as possible drawbacks, such as doubts about the correct form of use, forgetting the schedule, and even difficulty in accepting the use of insulin, considering it an aggression to the body.(9,10)
Summary
The pregnancy state is already defined as a condition of predisposition to diabetes, due to the production of placental enzymes (which act in the degradation of insulin), and hyperglycemic hormones This increases their production and tissue resistance, which can evolve to pancreatic cell dysfunction.(1) One of the consequences is gestational diabetes mellitus (GDM), which is a carbohydrate intolerance of variable severity. The use of glyburide in combination with metformin is already well established for treating type 2 diabetes in non-pregnant women Such an association may be a desirable approach for women with GDM with glucose levels that remain above the range despite the maximum tolerated by oral monotherapy.(8) This treatment has the potential to avoid discomfort of subcutaneous injections and the high costs of insulin therapy, as well as possible drawbacks, such as doubts about the correct form of use, forgetting the schedule, and even difficulty in accepting the use of insulin, considering it an aggression to the body.(9,10)
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