title: Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational diabetes requiring drug treatment.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Randomized controlled trials that fulfilled all the following: (1) published as full text; (2) addressed women with gestational diabetes requiring drug treatment; (3) compared glibenclamide v insulin, metformin v insulin, or metformin v glibenclamide; and (4) provided information on maternal or fetal outcomes.
  
  
  METHODS
  Medline, CENTRAL, and Embase were searched up to 20 May 2014.
  
  
  METHODS
  We considered 14 primary outcomes (6 maternal, 8 fetal) and 16 secondary (5 maternal, 11 fetal) outcomes.
  
  
  RESULTS
  We analyzed 15 articles, including 2509 subjects. Significant differences for primary outcomes in glibenclamide v insulin were obtained in birth weight (mean difference 109 g (95% confidence interval 35.9 to 181)), macrosomia (risk ratio 2.62 (1.35 to 5.08)), and neonatal hypoglycaemia (risk ratio 2.04 (1.30 to 3.20)). In metformin v insulin, significance was reached for maternal weight gain (mean difference -1.14 kg (-2.22 to -0.06)), gestational age at delivery (mean difference -0.16 weeks (-0.30 to -0.02)), and preterm birth (risk ratio 1.50 (1.04 to 2.16)), with a trend for neonatal hypoglycaemia (risk ratio 0.78 (0.60 to 1.01)). In metformin v glibenclamide, significance was reached for maternal weight gain (mean difference -2.06 kg (-3.98 to -0.14)), birth weight (mean difference -209 g (-314 to -104)), macrosomia (risk ratio 0.33 (0.13 to 0.81)), and large for gestational age newborn (risk ratio 0.44 (0.21 to 0.92)). Four secondary outcomes were better for metformin in metformin v insulin, and one was worse for metformin in metformin v glibenclamide. Treatment failure was higher with metformin than with glibenclamide.
  
  
  CONCLUSIONS
  At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available.Systematic review registration NCT01998113.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitari Mútua de Terrassa, Terrassa 8821, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Balsells
authors.affiliation: Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain.
authors.forename: Apolonia
authors.initials: A
authors.lastname: García-Patterson
authors.affiliation: Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona Institute of Biomedical Research (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau Barcelona CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Solà
authors.affiliation: Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona Institute of Biomedical Research (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau Barcelona CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Roqué
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona Department of Clinical Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Bellaterra 08193 (Cerdanyola del Vallès), Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Gich
authors.affiliation: Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain CIBER Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra rcorcoy@santpau.cat.
authors.forename: Rosa
authors.initials: R
authors.lastname: Corcoy
mesh_terms: D000328:Adult; D001724:Birth Weight; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology; D005905:Glyburide / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D005905:Glyburide