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Metformin compared with glyburide in gestational diabetes: a randomized controlled trial
Lisa E Moore1, Diana Clokey, Valerie J Rappaport
1From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Obstetrics and Gynecology
|December 23, 2009
Summary
Glyburide demonstrated a lower failure rate than metformin in managing gestational diabetes, with metformin requiring insulin therapy in significantly more patients. This highlights glyburide as a potentially more effective oral agent for gestational diabetes.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Pharmacology
Background:
- Gestational diabetes mellitus (GDM) requires effective glycemic management to prevent maternal and neonatal complications.
- Oral antihyperglycemic agents are increasingly used, necessitating comparative efficacy data.
Purpose of the Study:
- To compare the efficacy of metformin versus glyburide as monotherapy for achieving glycemic control in patients with gestational diabetes.
- To evaluate drug failure rates and associated neonatal and obstetric complications between the two treatment groups.
Main Methods:
- A randomized controlled trial involving patients with gestational diabetes unresponsive to diet alone.
- Participants were assigned to receive either metformin (n=75) or glyburide (n=74) as a single oral agent.
- Primary outcome: glycemic control; Secondary outcomes: drug failure rate, neonatal and obstetric complications.
Main Results:
- No statistically significant difference in mean fasting and 2-hour postprandial glucose levels between metformin and glyburide groups among those achieving control.
- A significantly higher proportion of patients in the metformin group (34.7%) required insulin compared to the glyburide group (16.2%) (P=.01).
- The failure rate for metformin was 2.1 times higher than for glyburide (95% CI 1.2-3.9).
Conclusions:
- Glyburide exhibited a lower failure rate than metformin in this cohort of gestational diabetes patients.
- Metformin failure necessitated insulin therapy in a substantially greater percentage of participants compared to glyburide.
- Glyburide may be a more effective oral agent for glycemic control in gestational diabetes when diet alone is insufficient.
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