Original Article

Journal of Perinatology (2007) 27, 262–267. doi:10.1038/sj.jp.7211683; published online 15 March 2007

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

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

G A Ramos1, G F Jacobson2, R S Kirby3, J Y Ching4 and D R Field2

  1. 1Reproductive Medicine Department, University of California, San Diego, CA, USA
  2. 2Departments of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, CA, USA
  3. 3Department of Maternal and Child Health, School of Public Health, University of Alabama-Birmingham, San Francisco, CA, USA
  4. 4Regional Perinatal Service Center, Kaiser Permanente Northern California, San Francisco, CA, USA

Correspondence: Dr GA Ramos, Department of Reproductive Medicine, UCSD, 200 West Arbor Drive, San Diego, CA 92103-8433, USA. E-mail: gramos@ucsd.edu

Received 24 August 2006; Revised 5 January 2007; Accepted 28 January 2007; Published online 15 March 2007.

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Abstract

Objective:

 

To compare the effectiveness of glyburide and insulin for the treatment of Gestational diabetes mellitus (GDM) in women who had OGCT greater than or equal to200 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 greater than or equal to200 mg/dl and pretreatment fasting plasma glucose greater than or equal to105 mg/dl. Exclusion criteria included pretreatment fasting greater than or equal to140 mg/dl, gestational age greater than or equal to34 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 (230plusminus25 vs 223plusminus23 mg/dl, P=0.07) and mean pretreatment fasting (120plusminus10 vs 119plusminus11 mg/dl, P=0.45). Seven women (16%) failed glyburide. Women in the insulin group were younger (31.5plusminus5.8 vs 35.2plusminus4.7 years, P<0.001) and had a higher mean BMI (32.4plusminus6.4 vs 29.1plusminus5.8 kg/m2, P=0.003) compared to glyburide group. There were no significant differences in birth weight (3524plusminus548 vs 3420plusminus786 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.

Keywords:

gestational diabetes mellitus, glyburide, insulin

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