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BMJ. 2015 Jan 21;350:h102. doi: 10.1136/bmj.h102.

Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis.

Author information

1
Department of Endocrinology and Nutrition, Hospital Universitari Mútua de Terrassa, Terrassa 8821, Spain.
2
Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain.
3
Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona Institute of Biomedical Research (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau Barcelona CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain.
4
CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona Department of Clinical Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Bellaterra 08193 (Cerdanyola del Vallès), Spain.
5
Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain CIBER Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra rcorcoy@santpau.cat.

Abstract

OBJECTIVE:

To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational diabetes requiring drug treatment.

DESIGN:

Systematic review and meta-analysis.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

Randomized controlled trials that fulfilled all the following: (1) published as full text; (2) addressed women with gestational diabetes requiring drug treatment; (3) compared glibenclamide v insulin, metformin v insulin, or metformin v glibenclamide; and (4) provided information on maternal or fetal outcomes.

DATA SOURCES:

Medline, CENTRAL, and Embase were searched up to 20 May 2014.

OUTCOMES MEASURES:

We considered 14 primary outcomes (6 maternal, 8 fetal) and 16 secondary (5 maternal, 11 fetal) outcomes.

RESULTS:

We analyzed 15 articles, including 2509 subjects. Significant differences for primary outcomes in glibenclamide v insulin were obtained in birth weight (mean difference 109 g (95% confidence interval 35.9 to 181)), macrosomia (risk ratio 2.62 (1.35 to 5.08)), and neonatal hypoglycaemia (risk ratio 2.04 (1.30 to 3.20)). In metformin v insulin, significance was reached for maternal weight gain (mean difference -1.14 kg (-2.22 to -0.06)), gestational age at delivery (mean difference -0.16 weeks (-0.30 to -0.02)), and preterm birth (risk ratio 1.50 (1.04 to 2.16)), with a trend for neonatal hypoglycaemia (risk ratio 0.78 (0.60 to 1.01)). In metformin v glibenclamide, significance was reached for maternal weight gain (mean difference -2.06 kg (-3.98 to -0.14)), birth weight (mean difference -209 g (-314 to -104)), macrosomia (risk ratio 0.33 (0.13 to 0.81)), and large for gestational age newborn (risk ratio 0.44 (0.21 to 0.92)). Four secondary outcomes were better for metformin in metformin v insulin, and one was worse for metformin in metformin v glibenclamide. Treatment failure was higher with metformin than with glibenclamide.

CONCLUSIONS:

At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available.Systematic review registration NCT01998113.

PMID:
25609400
PMCID:
PMC4301599
[Indexed for MEDLINE]
Free PMC Article

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