Glyburide non-inferior to insulin for perinatal outcomes in gestational diabetes

1. This population-based cohort study demonstrated that oral glyburide as first-line treatment for gestational diabetes (GDM) led to similar perinatal outcomes compared to subcutaneous insulin.

2. Current guidelines do not recommend glyburide as a first-line treatment for GDM; however, these results indicate that more studies are warranted to assess the long-term outcomes and reconsider existing recommendations.

Evidence Rating Level: 2 (Good)

Study Rundown: Gestational diabetes (GDM) is a common obstetrical complication associated with maternal and neonatal morbidity. Achieving optimal glycemic control is crucial in reducing complications. Despite lifestyle modifications, many women require pharmacological intervention to control their blood glucose. Glyburide is an oral antihyperglycemic agent preferred over subcutaneous insulin in many patients due to ease of use. Recent studies have demonstrated worse neonatal outcomes among women who used glyburide instead of insulin; however, these studies were accompanied by several limitations. This population-based cohort study evaluated the perinatal outcomes of glyburide versus insulin as a first-line medication for the treatment of GDM. This study included 11 321 patients and was conducted using medical records from patients between 2007 and 2017 within Kaiser Permanente Northern California. The primary outcomes included various perinatal and neonatal outcomes. The following results were adjusted for background characteristic differences and accounted for medication changes after initial medication therapy. Women treated with glyburide had a reduced risk of their child having neonatal respiratory distress (risk difference [RD]: 2.03 [95% CI: 0.13-3.92] per 100 births lower) or requiring NICU admission (RD: 3.32 [95% CI: 0.20-6.45] per 100 births lower) compared to those treated with insulin. There were no significant differences found in other neonatal outcomes, such as hypoglycemia (RD: 0.85 [95% CI: -1.17 to 2.86] per 100 births lower) or jaundice (RD: 0.02 [95% CI: -1.46 to 1.51] per 100 births lower) in glyburide-treated compared to insulin-treated patients. Furthermore, there was no significant difference between treatment cohorts in the risk of cesarean delivery. Overall, this study demonstrated that glyburide treatment for GDM is safe regarding perinatal outcomes compared to subcutaneous insulin. One limitation of this study, however, is the drastic difference in cohort sizes (91% used glyburide versus 9% treated with insulin).

Click to read the study in JAMA Network Open

Relevant Reading: Can glyburide be advocated over subcutaneous insulin for perinatal outcomes of women with gestational diabetes? A systematic review and meta-analysis

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