Predicting failure of glyburide therapy in gestational diabetes

Abstract

Objective:

We sought to develop a prediction model to identify women with gestational diabetes (GDM) who require insulin to achieve glycemic control.

Study Design:

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.

Result:

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.

Conclusion:

Women with GDM who will require insulin can be identified at the initiation of pharmacological therapy.