Glyburide in gestational diabetes--prediction of treatment failure.
OBJECTIVE
To identify factors predicting failure of glyburide treatment in women with gestational diabetes mellitus (GDM).


METHODS
A retrospective study of all women with GDM that were treated with glyburide in a single tertiary referral center. Patients were switched from glyburide to insulin if they failed to achieve glycemic goals, and were then classified as glyburide failure.


RESULTS
Overall, 124 women with GDM treated with glyburide were included in the study, of which 31 (25%) failed to achieve glycemic control. Women in the failure group were characterized by a higher weight gain during pregnancy, higher rates of GDM on previous pregnancies, and a glucose challenge test (GCT) result. On multivariate logistic regression analysis, a GCT value of >200 mg/dl (OR = 7.1, 95% CI 2.8-27.6) and weight gain ≥ 12 kg (OR = 3.9, 95% CI 1.2-13.0) were the only significant and independent predictors of glyburide failure. Most women who were successfully treated with glyburide required a daily dose of 5 mg or less and the time required to achieve glycemic control in these cases was 12.4 ± 4.9 days (range 5-24 days). Of the women who failed to achieve glycemic control with gluburide, 26/31 were switched to insulin, of them only 12 (46%) achieved desired level of glycemic control.


CONCLUSIONS
Most women with GDM achieved desired level of glycemic control under glyburide treatment.
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa, Israel. yarivyogev@hotmail.com
Yariv
Y
Yogev
Nir
N
Melamed
Rony
R
Chen
Daniel
D
Nassie
Joseph
J
Pardo
Moshe
M
Hod
D000328:Adult; D054316:Biomarkers, Pharmacological / Q000032:analysis; D001724:Birth Weight / Q000187:drug effects / Q000502:physiology; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D005905:Glyburide / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure
D054316:Biomarkers, Pharmacological; D007004:Hypoglycemic Agents; D005905:Glyburide