title: Predicting failure of glyburide therapy in gestational diabetes.
abstract: We sought to develop a prediction model to identify women with gestational diabetes (GDM) who require insulin to achieve glycemic control.
  
  
  
  Retrospective cohort of all singletons with GDM treated with glyburide from 2007 to 2013. Glyburide failure was defined as reaching glyburide 20 mg day(-1) and receiving insulin. Glyburide success was defined as any glyburide dose without insulin and >70% of visits with glycemic control. Multivariable logistic regression analysis was performed to create a prediction model.
  
  
  
  Of the 360 women, 63 (17.5%) qualified as glyburide failure and 157 (43.6%) as glyburide success. The final prediction model for glyburide failure included prior GDM, GDM diagnosis ⩽26 weeks, 1-h glucose challenge test ⩾228 mg dl(-1), 3-h glucose tolerance test 1-h value ⩾221 mg dl(-1), ⩾7 postprandial blood sugars >120 mg dl(-1) in the week glyburide started and ⩾1 blood sugar >200 mg dl(-1). The model accurately classified 81% of subjects.
  
  
  
  Women with GDM who will require insulin can be identified at the initiation of pharmacological therapy.
authors.affiliation: Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Harper
authors.affiliation: Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: A V
authors.initials: AV
authors.lastname: Glover
authors.affiliation: Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Biggio
authors.affiliation: Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Tita
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D004351:Drug Resistance; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods*; D005905:Glyburide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007328:Insulin / Q000627:therapeutic use*; D008487:Medical History Taking / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure; D014481:United States
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005905:Glyburide