Abstract
Background: Insulin therapy has been the mainstay in managing women with gestational diabetes mellitus (GDM), but some disadvantages of insulin have led to the use of glyburide, which is in- expensive in some countries, to manage GDM. However, there has been debate over its effective- ness, efficacy and safety when compared to insulin for maternal glycaemic control, and some ad- verse neonatal outcomes in GDM. Method: A systematic review of eight randomised controlled trial (RCT) studies was undertaken to compare glyburide and insulin. Studies involving 849 parti- cipants were included in the quantitative analysis. Results: There was no significant difference be- tween glyburide and insulin in maternal fasting (P = 0.09; SMD: 0.13; 95% CI: −0.02 to 0.28) and postprandial (P = 0.45; SMD: 0.05; 95% CI: −0.09 to 0.19) glycaemic control and glycosylated hae- moglobin (P = 0.35; SMD: 0.08; 95% CI: −0.08 to 0.24). When compared with insulin, glyburide had an increase risk ratio (RR) for neonatal hypoglycaemia (P = 0.0002; RR: 2.27; 95% CI: 1.47 to 3.51) and large for gestational age babies (P = 0.03; RR: 1.60; 95% CI: 1.06 to 2.41). Estimation of stan- dard mean difference shows that neonatal birth weight was significantly higher in subjects re- ceiving glyburide than in the insulin group (P = 0.002; SMD: 0.21; 95% CI: 0.08 to 0.35). Conclu- sions: Glyburide was seen to be clinically effective and a safer alternative to insulin for maternal glycaemic control in GDM women. It is affordable, convenient and requires no comprehensive educative training at the time of initiation of therapy. However, its adverse outcomes—neonatal hypoglycaemia, high neonatal birth weight and large for gestational age babies—call for careful monitoring of GDM patients for any need for supplemental insulin.
Highlights
Gestational diabetes mellitus (GDM) is associated with about 14% of complicated pregnancy cases per annum
Both glyburide and insulin subjects were matched for age, body mass index, gestational weeks, fasting and 2-hour postprandial blood glucose, and glycosylated haemoglobin level at the time of entry to the study
The average blood glucose was slightly lower in the insulin group than the glyburide group, but the difference was not statistically significant (P = 0.09; standardised mean differences (SMD): 0.13; 95% confidence intervals (CI): −0.02 to 0.28) and the 95% confidence interval crosses the line of no effect
Summary
Gestational diabetes mellitus (GDM) is associated with about 14% of complicated pregnancy cases per annum. There has been debate over its effectiveness, efficacy and safety when compared to insulin for maternal glycaemic control, and some adverse neonatal outcomes in GDM. Glyburide had an increase risk ratio (RR) for neonatal hypoglycaemia (P = 0.0002; RR: 2.27; 95% CI: 1.47 to 3.51) and large for gestational age babies (P = 0.03; RR: 1.60; 95% CI: 1.06 to 2.41). Conclusions: Glyburide was seen to be clinically effective and a safer alternative to insulin for maternal glycaemic control in GDM women. It is affordable, convenient and requires no comprehensive educative training at the time of initiation of therapy. Its adverse outcomes—neonatal hypoglycaemia, high neonatal birth weight and large for gestational age babies—call for careful monitoring of GDM patients for any need for supplemental insulin
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