INSULIN not Glyburide Should t Be First-Line for Gestational Diabetes

INSULIN not Glyburide Should t Be First-Line for Gestational Diabetes

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The oral sulfonylurea glyburide should not be considered as a first-line treatment for gestational diabetes, new research suggests.Results from the first randomized trial to compare neonatal outcomes of women with gestational diabetes treated with oral glyburide versus subcutaneous insulin were published online May 1 in JAMA by Marie-Victoire Sénat, MD, PhD, Department of Obstetrics and Gynecology, Hôpital Bicêtre, Le Kremlin Bicêtre, France, and colleagues.  

         The authors also point out that the results suggest the increase in perinatal complications with glyburide — macrosomia, neonatal hypoglycemia, and hyperbilirubinemia — may be no more than 10.5% compared with insulin, and that the risk should be balanced with ease of use and patient satisfaction with glyburide."In clinical situations in which an oral agent may be necessary, mothers, informed by their physicians, would be appropriate decision makers based on their own weighing of benefits and risks."

                But in an accompanying editorial, obstetrician-gynecologist Donald R. Coustan, MD, of Brown University, Jamestown, Rhode Island, and endocrinologist Linda Barbour, MD, University of Colorado Hospital, Aurora, note another concern, the fact that few data are available on the long-term effects of glyburide on the fetus."Whether glyburide levels are high enough to stimulate fetal insulin or whether exposing the fetal pancreas to an insulin secretagogue during critical stages of development would be harmful or helpful is not known," they write.

                   Given that, and the possible 10.5% increased perinatal complication risk, Coustan and Barbour conclude: "Use of glyburide may be most appropriate when insulin injections are not acceptable or practical. When glyburide or other oral agents that cross the placenta are prescribed for pregnant women, concerns about the equivalence in perinatal outcomes and unanswered questions regarding long-term effects on offspring should be discussed frankly."

                  Both the American Diabetes Association and American College of Obstetricians recommend only insulin as first-line gestational diabetes treatment, and it's the only gestational diabetes medication approved by the US Food and Drug Administration. Nonetheless, glyburide use in gestational diabetes has become common in the United States (but not in Europe).