Glyburide for the treatment of gestational diabetes. A critical appraisal.
The clinical experience with glyburide treatment of GDM has moved ahead of the science. A single randomized controlled trial of glyburide versus insulin indicates that glyburide treatment can provide a relatively safe alternative to insulin therapy. Subsequent retrospective trials have shown that up to 20% of GDM patients, especially those with substantial pretreatment hyperglycemia, are likely to require adjunctive or alternative therapy with insulin. These follow-on trials have also demonstrated that glyburide treatment, compared with insulin, actually results in lower mean glucose values and a higher percentage of "excellent glycemic control" with fewer hypoglycemic episodes. With the emerging view that glyburide treatment compared with insulin improves glycemic profiles, it should be expected to reduce the frequency of newborn obesity. Larger randomized controlled trials are necessary to clarify this question and the concerns regarding neonatal metabolic morbidity in glyburide-treated offspring.
Moore
Thomas R
TR
Department of Reproductive Medicine, School of Medicine, University of California San Diego, 200 W. Arbor Drive, MPF 170, San Diego, CA 92103, USA. trmoore@ucsd.edu
D000284:Administration, Oral; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D005905:Glyburide / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D007004:Hypoglycemic Agents; D007328:Insulin; D005905:Glyburide