A team of researchers at the University of Maryland, Duke University and the University of North Carolina at Chapel Hill recently published in the journal JAMA Pediatrics findings indicating that the anti diabetic drug glyburide is linked to more adverse outcomes in women with gestational diabetes compared to insulin treatment. The study is entitled “Association of Adverse Pregnancy Outcomes With Glyburide vs Insulin in Women With Gestational Diabetes.”
Gestational diabetes mellitus is a condition characterized by inappropriately elevated blood sugar levels during pregnancy. It is estimated that around 7% of all pregnancies are complicated by gestational diabetes mellitus. Glyburide is considered to be safe in the treatment of gestational diabetes although its effectiveness in comparison with insulin treatment has been poorly studied.
Researchers conducted a retrospective population-based cohort study where 110,879 women with gestational diabetes were assessed from a nationwide U.S. employer-based insurance database between 2000 and 2011 with the goal of determining the risk of adverse outcomes, both maternal and neonatal, upon treatment with either glyburide or insulin. Women with type 1 or 2 diabetes, younger than 15 years, or older than 45 years were excluded from the study. In total, 4,982 women treated with glyburide and 4,191 women treated with insulin within 150 days before delivery were evaluated.
Researchers found that newborns of women under glyburide treatment had an increased risk for neonatal intensive care unit admission (NICU), hypoglycemia, respiratory distress, birth injury, and were found to be large for their gestational age in comparison with newborns from mothers treated with insulin. These newborns were, on the other hand, not at increased risk for preterm birth, obstetric trauma or jaundice. The risk of cesarean delivery was also found to be 3% lower in mothers treated with glyburide in comparison with the ones treated with insulin.
“The convenience factor makes glyburide an attractive option for women with gestational diabetes, but, in light of these findings, we need to better understand which patients can be managed effectively with this drug,” noted Dr. Michele Jonsson Funk of the University of North Carolina at Chapel Hill in a news release.
“After accounting for maternal comorbidities and risk factors for neonatal outcomes, we found an association between glyburide (compared with insulin) and elevated risk of NICU admission, neonatal hypoglycemia, respiratory distress, birth injury and large for gestation age in women with [gestational diabetes],” wrote the research team. “These results are consistent with findings from prior studies and suggest that women with [gestational diabetes] being treated with glyburide may not be achieving adequate glucose control.”
The research team believes that given the widespread use of glyburide, further analyses should be performed to assess pregnancy outcomes and improve the management of diabetes during pregnancy to reduce fetal and maternal morbidity.