TITLE:
The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review
AUTHORS:
Jephthah O. Odiba, Mzwandile A. Mabhala
KEYWORDS:
Gestational Diabetes Mellitus, Glyburide, Insulin
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.5 No.2,
April
24,
2015
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 inexpensive in some countries, to manage GDM. However, 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. Method: A
systematic review of eight randomised controlled trial (RCT) studies was undertaken
to compare glyburide and insulin. Studies involving 849 participants were
included in the quantitative analysis. Results: There was no significant
difference between 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 standard mean difference shows that neonatal
birth weight was significantly higher in subjects receiving glyburide than in
the insulin group (P = 0.002; SMD: 0.21; 95% CI: 0.08 to 0.35). 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. However, its adverse outcomes—neonatal hypogly-caemia,
high neonatal birth weight and large for gestational age babies—call for
careful monitoring of GDM patients for any need for supplemental insulin.