In a nutshell
This study compared the effects of two drugs, metformin (Glucophage) and glyburide (DiaBeta), in the treatment of gestational diabetes mellitus (GDM). The study also examined a combination of the two drugs. It found that the effectiveness and safety of the drugs was similar, and that using a combination reduced the need to use insulin.
Some background
Insulin is made in the pancreas and lowers levels of glucose in the blood. Hormones produced in pregnancy increase blood glucose. GDM occurs when the mother cannot produce enough insulin to balance this effect. This causes a rise in blood glucose levels, which can pass to the developing baby through the placenta.
Metformin is a drug that reduces the amount of glucose produced in the body. Glyburide is a type of drug called a sulfonylurea. These drugs increase the release of insulin from the pancreas, which lowers blood glucose.
Both metformin and glyburide have been shown to be effective in treating GDM. However, evidence comparing the two is limited, and using the two in combination has not been examined.
Methods & findings
104 women with GDM not controlled by dietary changes were recruited for this study. Roughly half (53 patients) received glyburide, and the others (51 patients) received metformin. Blood glucose levels were recorded daily by the participants, and sent to a physician. The participants were followed up at a clinic, at least once a month, until delivery. If the medication failed to control blood glucose levels, then the other medication was added.
34% of patients receiving glyburide needed to receive metformin. In 6 patients (11%) this was because the patients experienced hypoglycemia (dangerously low blood glucose). In 12 patients (23%) blood glucose was not adequately controlled, and they received the combination.
29% of patients receiving metformin needed to receive glyburide. In 1 patient (2%) this was because they experienced gastrointestinal discomfort. This patient switched to glyburide. In 14 patients (28%) blood glucose was not adequately controlled, and they received the combination.
Half of patients who started with glyburide and were then treated with the combination needed insulin treatment because blood glucose was still not adequately controlled. This occurred in just 13% of the patients (2 patients) who started with metformin and then received the combination. The combination of drugs lowered the need for insulin from 32% to 11%.
The bottom line
The study concluded that metformin and glyburide were similarly effective in treating GDM. Glyburide may cause more side effects. They also concluded that using a combination of metformin and glibenclamide prevented the need for insulin in some patients.
The fine print
This study examined a relatively small sample of just 104 patients.
What’s next?
Discuss the use of metformin and glyburide, alone and in combination, with your physician.
Published By :
Diabetes Care
Date :
Jan 11, 2017
