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Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia

Journal of Perinatology volume 27, pages 262–267 (2007)Cite this article

Abstract

Objective:

To compare the effectiveness of glyburide and insulin for the treatment of Gestational diabetes mellitus (GDM) in women who had OGCT ⩾200 mg/dl and fasting hyperglycemia.

Study design:

A retrospective study was performed among a subset of women treated with glyburide or insulin for GDM from 1999 to 2002 with an OGCT ⩾200 mg/dl and pretreatment fasting plasma glucose ⩾105 mg/dl. Exclusion criteria included pretreatment fasting ⩾140 mg/dl, gestational age ⩾34 weeks and multiple gestation. Maternal and neonatal outcomes were assessed. Statistical methods included bivariate and multivariable logistic regression analyses.

Results:

In 1999 to 2000, 78 women were treated with insulin; in 2001 to 2002, 44 of 69 (64%) received glyburide. There were no statistically significant differences between the two groups with regards to mean OGCT (230±25 vs 223±23 mg/dl, P=0.07) and mean pretreatment fasting (120±10 vs 119±11 mg/dl, P=0.45). Seven women (16%) failed glyburide. Women in the insulin group were younger (31.5±5.8 vs 35.2±4.7 years, P<0.001) and had a higher mean BMI (32.4±6.4 vs 29.1±5.8 kg/m2, P=0.003) compared to glyburide group. There were no significant differences in birth weight (3524±548 vs 3420±786 g, P=0.65), macrosomia (19 vs 23%, P=0.65), pre-eclampsia (12 vs 11%, P=0.98) or cesarean delivery (39 vs 46%, P=0.45). Neonates in the glyburide group were diagnosed more frequently with hypoglycemia (34 vs 14%, P=0.01). When controlled for confounders, macrosomia was found to be associated with glyburide treatment (OR 3.5, 95% CI 1.1 to 11.4).

Conclusion:

In women with GDM who had a markedly elevated OGCT and fasting hyperglycemia, glyburide achieved similar birth weights and delivery outcomes but was associated with an increased risk of macrosomia. The possible increased risk of neonatal hypoglycemia in the glyburide group warrants further investigation.

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References

  1. American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics Coustan DR . Gestational Diabetes ACOG Practice Bulletin, Number 30. American College of Obstetricians and Gynecologists: Washington, September 2001.

  2. Metzger BE, Coustan DR . Summary of recommendations of the Fourth International Workshop–Conference on gestational diabetes mellitus. Diabetes care 1998; 21 (S2): 161–167.

    Google Scholar 

  3. Shivvers SA, Lucas MJ . Gestational diabetes: is a 50-g screening result ⩾200 mg/dL diagnostic? J Reprod Med 1999; 44: 685–688.

    CAS  PubMed  Google Scholar 

  4. Sacks DA, Chen WMS, Wolde-Tsadik G, Buchanan TA . Fasting plasma glucose test at the first prenatal visit as a screen for gestational diabetes. Obstet Gynecol 2003; 101: 1197–1203.

    PubMed  Google Scholar 

  5. Perucchini D, Fischer U, Spinas GA, Huch R, Huch A, Lehmann R . Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. BMJ 1999; 319: 812–815.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Atilano L, Lee-Parritz A, Lieberman E, Cohen AP, Barbieri RL . Alternative methods of diagnosing gestational diabetes mellitus. Am J Obstet Gynecol 1999; 181: 1158–1161.

    Article  CAS  PubMed  Google Scholar 

  7. Guidelines for Care; State Program Guide; California Diabetes and Pregnancy Program Maternal and Child Health Branch, Department of Heath Services, State of California, 1998.

  8. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O . A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343: 1134–1138.

    Article  CAS  PubMed  Google Scholar 

  9. Jacobson GJ, Ramos GA, Ching JY, Kirby RS, Ferrara A, Field DR . Comparison of glyburide and insuliln for the management of gestational diabetes in a large managed care organization. Am J Obstet Gynecol 2005; 193 (1): 118–124.

    Article  CAS  PubMed  Google Scholar 

  10. Gabbe SG, Graves CR . Management of diabetes mellitus complicating pregnancy. Obstet Gynecol 2003; 102: 857–868.

    PubMed  Google Scholar 

  11. Gabbe SG, Gregory RP, Power ML, Williams SB, Schulkin J . Management of diabetes mellitus by obstetrician-gynecologists. Obstet Gynecol 2004; 103: 1229–1234.

    Article  PubMed  Google Scholar 

  12. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28: 1039–1057.

    Article  Google Scholar 

  13. Shapiro SS, Wilk MD . An analysis of variance test for normality (complete samples). Biometrika 1965; 52: 591–611.

    Article  Google Scholar 

  14. Gilson G, Murphy N . Comparison of oral glyburide with insulin for the management of gestational diabetes mellitus in Alaska Native women. Am J Obstet Gynecol 2002; 187 (6): S152.

    Google Scholar 

  15. Velazquez MD, Bolnick J, Cloakey D, Gonzalez JL, Curet LB . The use of glyburide in the management of gestational diabetes. Obstet Gynecol 2003; 101 (4 Suppl): 88S.

    Google Scholar 

  16. Conway DL, Gonzales O, Skiver D . Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. J Mat-Fet and Neon Med 2004; 15: 51–55.

    CAS  Google Scholar 

  17. Fines VL, Moore TR, Castle SL . A comparison of glyburide and insulin treatment in gestational diabetes mellitus on infant birth weight and adiposity. Am J Obstet Gynecol 2003; 189 (6): S161.

    Article  Google Scholar 

  18. Chmait R, Dinise T, Moore T . Prospective observational study to establish predictors of glyburide success in women with gestational diabetes mellitus. J Perinat 2004; 10: 617–622.

    Article  Google Scholar 

  19. Cowett RM, Susa JB, Giletti B, Oh W, Schwartz R . Glucose kinetics in infants of diabetic mothers. Am J Obstet Gynecol 1983; 146 (7): 781–786.

    Article  CAS  PubMed  Google Scholar 

  20. Langer O, Yogen Y, Xenakis E, Rosenn B . Insulin and glyburide therapy:dosage, severity of gestational diabetes, and pregnancy outcome. Am J Obstet Gynecol 2005; 192 (1): 134–139.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Dayakar Beeravolu, John Greene and Marla Gardner for their assistance in database abstraction.

Author information

Authors and Affiliations

  1. Reproductive Medicine Department, University of California, San Diego, CA, USA

    G A Ramos

  2. Departments of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, CA, USA

    G F Jacobson & D R Field

  3. Department of Maternal and Child Health, School of Public Health, University of Alabama-Birmingham, San Francisco, CA, USA

    R S Kirby

  4. Regional Perinatal Service Center, Kaiser Permanente Northern California, San Francisco, CA, USA

    J Y Ching

Authors
  1. G A Ramos
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  2. G F Jacobson
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  3. R S Kirby
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  4. J Y Ching
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  5. D R Field
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Corresponding author

Correspondence to G A Ramos.

Additional information

Location study conducted: Northern California. Poster presentation at the Society for Maternal Fetal Medicine 26th Annual Scientific Meeting, January 29, 2006, in Miami, FL.

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Ramos, G., Jacobson, G., Kirby, R. et al. Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia. J Perinatol 27, 262–267 (2007). https://doi.org/10.1038/sj.jp.7211683

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